Provider Demographics
NPI:1457415317
Name:ZADOW, BOB GILBERTR (MS, LCPC)
Entity Type:Individual
Prefix:MR
First Name:BOB
Middle Name:GILBERTR
Last Name:ZADOW
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 S STREVELL AVE
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-4918
Mailing Address - Country:US
Mailing Address - Phone:406-234-2592
Mailing Address - Fax:
Practice Address - Street 1:2000 CLARK ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2726
Practice Address - Country:US
Practice Address - Phone:406-234-4885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLCPC 595101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health