Provider Demographics
NPI:1568756302
Name:ZASTROW, VIVIANE MARIE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:VIVIANE
Middle Name:MARIE
Last Name:ZASTROW
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 1:18986 LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9348
Mailing Address - Country:US
Mailing Address - Phone:952-401-4869
Mailing Address - Fax:952-474-3652
Practice Address - Street 1:200 W 98TH ST STE 107
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-4858
Practice Address - Country:US
Practice Address - Phone:612-968-6297
Practice Address - Fax:612-435-9842
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN170781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical