Provider Demographics
NPI:1326934076
Name:WILSON, ZACHARY DOUGLAS
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:DOUGLAS
Last Name:WILSON
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 1:228 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50315-7624
Mailing Address - Country:US
Mailing Address - Phone:563-379-6909
Mailing Address - Fax:
Practice Address - Street 1:3636 WESTOWN PKWY STE 204
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6713
Practice Address - Country:US
Practice Address - Phone:515-505-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-17
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA130458104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker