Individual
ZACKIE KANISHKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
255 S OREM BLVD, OREM, UT 84058-3009
(385) 368-5000
Mailing address
750 N FREEDOM BLVD, PROVO, UT 84601-1677
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
9524947-3502
UT
Other
Enumeration date
07/01/2019
Last updated
07/30/2026
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