Provider Demographics
NPI:1427596246
Name:ZEITZ, NATAILE ZAMORA (LICSW)
Entity Type:Individual
Prefix:
First Name:NATAILE
Middle Name:ZAMORA
Last Name:ZEITZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-7629
Mailing Address - Country:US
Mailing Address - Phone:612-791-0055
Mailing Address - Fax:952-945-4238
Practice Address - Street 1:23 9TH AVE S
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7629
Practice Address - Country:US
Practice Address - Phone:612-791-0055
Practice Address - Fax:952-945-4238
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN227771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical