Provider Demographics
NPI:1144599580
Name:ZIMMERMAN, RAE BEVERLY (SLP)
Entity Type:Individual
Prefix:
First Name:RAE
Middle Name:BEVERLY
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:SLP
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 822
Mailing Address - Street 2:
Mailing Address - City:WHITE CLOUD
Mailing Address - State:MI
Mailing Address - Zip Code:49349-0822
Mailing Address - Country:US
Mailing Address - Phone:231-689-6800
Mailing Address - Fax:231-689-5802
Practice Address - Street 1:220 S. CHARLES ST
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:MI
Practice Address - Zip Code:49349-8794
Practice Address - Country:US
Practice Address - Phone:231-689-5800
Practice Address - Fax:231-689-5802
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist