Individual
ZULEIKA PROVSTGAARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1007 KOALA DR, OMAK, WA 98841-9247
(509) 826-6191
Mailing address
1007 KOALA DR, OMAK, WA 98841-9247
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
175T00000X
Peer Specialist
Primary
CG61653497
—
Other
Enumeration date
03/04/2025
Last updated
03/04/2025
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