Provider Demographics
NPI:1528590254
Name:NZUKI, ISAAC (BACB)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:NZUKI
Suffix:
Gender:M
Credentials:BACB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 BROADWAY ST STE 504
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-7331
Mailing Address - Country:US
Mailing Address - Phone:618-697-1132
Mailing Address - Fax:
Practice Address - Street 1:338 BROADWAY ST STE 504
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-7331
Practice Address - Country:US
Practice Address - Phone:618-697-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017000673103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst