Provider Demographics
NPI:1114355849
Name:ZIMMERMAN, DANIELLE FAITH (LCPC)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:FAITH
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MAIN ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8957
Mailing Address - Country:US
Mailing Address - Phone:815-556-9144
Mailing Address - Fax:
Practice Address - Street 1:67 MAIN ST STE 2B
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8957
Practice Address - Country:US
Practice Address - Phone:815-556-9144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional