Provider Demographics
NPI:1891146601
Name:ZIPPER, HEATHER DIANE (MS)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DIANE
Last Name:ZIPPER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DIANE
Other - Last Name:BOTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5445 LAUREL HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95841-3105
Mailing Address - Country:US
Mailing Address - Phone:916-609-5189
Mailing Address - Fax:916-609-5160
Practice Address - Street 1:5445 LAUREL HILLS DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95841-3105
Practice Address - Country:US
Practice Address - Phone:916-609-5189
Practice Address - Fax:916-609-5160
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAIMF94093106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator