Provider Demographics
NPI:1932891462
Name:SMEAD, ZOE MARIE
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:MARIE
Last Name:SMEAD
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 1:331 NW 82ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98117-4033
Mailing Address - Country:US
Mailing Address - Phone:253-652-8561
Mailing Address - Fax:
Practice Address - Street 1:331 NW 82ND ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-4033
Practice Address - Country:US
Practice Address - Phone:253-652-8561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACB61364943106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician