Provider Demographics
NPI:1295323830
Name:ZEGIESTOWSKY, NICOLE (MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ZEGIESTOWSKY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12422 LANDMARK ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3813
Mailing Address - Country:US
Mailing Address - Phone:484-374-8021
Mailing Address - Fax:
Practice Address - Street 1:4000 SAN ERNESTO AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2874
Practice Address - Country:US
Practice Address - Phone:907-729-5020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health