Provider Demographics
NPI:1760201958
Name:IRVIN-HAYWARD, ZACHARY AMBROSE
Entity type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:AMBROSE
Last Name:IRVIN-HAYWARD
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 1:1220 MCGEE CT NE APT 103
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-9442
Mailing Address - Country:US
Mailing Address - Phone:971-599-0521
Mailing Address - Fax:
Practice Address - Street 1:2600 CENTER ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2682
Practice Address - Country:US
Practice Address - Phone:593-945-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty