Provider Demographics
NPI:1093211062
Name:ZIMMERMAN, KATHERINE (CAC, CSW-PIP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:CAC, CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:
Practice Address - Street 1:6110 S MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2549
Practice Address - Country:US
Practice Address - Phone:605-328-5800
Practice Address - Fax:605-328-5814
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD12091552101YA0400X
SD51971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)