Provider Demographics
NPI:1649943242
Name:ZASTROW, EMILY MAY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MAY
Last Name:ZASTROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48634-0248
Mailing Address - Country:US
Mailing Address - Phone:989-313-5744
Mailing Address - Fax:
Practice Address - Street 1:506 W GUY ST
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:MI
Practice Address - Zip Code:48634-9202
Practice Address - Country:US
Practice Address - Phone:989-313-5744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician