Provider Demographics
NPI:1073839338
Name:ZIMMER, AMBER D (MSE, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:D
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:MSE, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:ROBERTS
Mailing Address - State:WI
Mailing Address - Zip Code:54023
Mailing Address - Country:US
Mailing Address - Phone:715-749-3890
Mailing Address - Fax:749-749-4081
Practice Address - Street 1:204 W WARREN ST
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:WI
Practice Address - Zip Code:54023
Practice Address - Country:US
Practice Address - Phone:715-749-3890
Practice Address - Fax:715-749-4081
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3261-154235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist