Aunastasia Fantasia Marie Zsidiewicz, LICSWA, AAC, CADC I

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

SC61098820 Issued in WA

Practice address

65 N Highway 101 Ste 204
Warrenton, OR 97146-9371

Phone

(503) 325-0241

Fax

(503) 861-2043

NPI assigned

Nov 5, 2018

Last updated

Nov 5, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 13, 2024 through Oct 13, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Breaking Boulders Counseling LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Hardwood, MI
  • NPI 1093405805
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1689142085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 N HIGHWAY 101 STE 204",
            "city": "WARRENTON",
            "state": "OR",
            "postal_code": "971469371",
            "telephone_number": "503-325-0241",
            "fax_number": "503-861-2043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 N HIGHWAY 101 STE 204",
            "city": "WARRENTON",
            "state": "OR",
            "postal_code": "971469371",
            "telephone_number": "503-325-0241",
            "fax_number": "503-861-2043"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2120 Exchange St Ste 203",
            "address_purpose": "LOCATION",
            "city": "Astoria",
            "state": "OR",
            "postal_code": "971033364",
            "country_code": "US",
            "telephone_number": "503-325-0241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZSIDIEWICZ",
        "first_name": "AUNASTASIA",
        "middle_name": "FANTASIA MARIE",
        "credential": "LICSWA, AAC, CADC I",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-05",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "SC61098820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wendi Wyrwitzke
• Shawna Marie Zamora
• Steven Ray Zamora
• Kelsy Ziegemeier, PHARMD
• Warren Zimmermann Jr., RN, MSN

• Clinical Social Worker in Warrenton, OR
• Providers in Warrenton, OR by specialty
• Clinical Social Worker in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.