Provider Demographics
NPI:1134288392
Name:ZIMMEL, TAMMY LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LYNN
Last Name:ZIMMEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 N GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3501
Mailing Address - Country:US
Mailing Address - Phone:262-636-9920
Mailing Address - Fax:262-598-9023
Practice Address - Street 1:3701 DURAND AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4458
Practice Address - Country:US
Practice Address - Phone:262-554-9846
Practice Address - Fax:262-598-9032
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2225-057103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000044248Medicare ID - Type Unspecified