Provider Demographics
NPI:1669881165
Name:ZABALLA, ILEANNA
Entity type:Individual
Prefix:
First Name:ILEANNA
Middle Name:
Last Name:ZABALLA
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 1:5621 22ND AVE NW APT 412
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3472
Mailing Address - Country:US
Mailing Address - Phone:360-213-9626
Mailing Address - Fax:
Practice Address - Street 1:6908 30TH AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-3768
Practice Address - Country:US
Practice Address - Phone:206-930-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60487846101Y00000X
WAOT61038681225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor