Basic Information
| Provider Information | |||||||||
| NPI: | 1689142085 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZSIDIEWICZ | ||||||||
| FirstName: | AUNASTASIA | ||||||||
| MiddleName: | FANTASIA MARIE | ||||||||
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| Credential: | LICSWA, AAC, CADC I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 65 N HIGHWAY 101 STE 204 | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971469371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033250241 | ||||||||
| FaxNumber: | 5038612043 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 N HIGHWAY 101 STE 204 | ||||||||
| Address2: | |||||||||
| City: | WARRENTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971469371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033250241 | ||||||||
| FaxNumber: | 5038612043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2018 | ||||||||
| LastUpdateDate: | 11/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | SC61098820 | WA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.