Provider Demographics
NPI:1780569764
Name:ZOLLINGER, ETHAN
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:ZOLLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 W 2350 S
Mailing Address - Street 2:
Mailing Address - City:NIBLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6199
Mailing Address - Country:US
Mailing Address - Phone:435-999-4101
Mailing Address - Fax:
Practice Address - Street 1:75 W 100 S
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4550
Practice Address - Country:US
Practice Address - Phone:801-896-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health