Provider Demographics
NPI:1336298306
Name:DIER - ZIMMERMANN, MARY ANN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:DIER - ZIMMERMANN
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 1:204 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:VILLA GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:61956-1732
Mailing Address - Country:US
Mailing Address - Phone:815-573-1443
Mailing Address - Fax:
Practice Address - Street 1:201 PARK PL STE 2
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-1883
Practice Address - Country:US
Practice Address - Phone:815-573-1443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-001433101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional