Provider Demographics
NPI:1750426482
Name:ZALKASKE, SUSAN GILLEY (MA)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:GILLEY
Last Name:ZALKASKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 RANCHO LINDO DR
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-4886
Mailing Address - Country:US
Mailing Address - Phone:707-765-9159
Mailing Address - Fax:707-765-9444
Practice Address - Street 1:1500 PETALUMA BLVD S STE A
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-5546
Practice Address - Country:US
Practice Address - Phone:707-765-2464
Practice Address - Fax:707-765-8482
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF40387101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health