Provider Demographics
NPI:1629804059
Name:ZUCKER, JO ELLEN
Entity type:Individual
Prefix:
First Name:JO
Middle Name:ELLEN
Last Name:ZUCKER
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 1:66900 SAGEBRUSH LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-9292
Mailing Address - Country:US
Mailing Address - Phone:541-788-8484
Mailing Address - Fax:
Practice Address - Street 1:2955 N HWY 97
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7559
Practice Address - Country:US
Practice Address - Phone:541-203-0474
Practice Address - Fax:541-610-1692
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty