Provider Demographics
NPI:1801335120
Name:ZAJA, AMIE MARIE (CSAC)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:MARIE
Last Name:ZAJA
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 E COOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-2313
Mailing Address - Country:US
Mailing Address - Phone:608-434-3686
Mailing Address - Fax:
Practice Address - Street 1:706 E COOK ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-2313
Practice Address - Country:US
Practice Address - Phone:608-434-3686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16066-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)