Provider Demographics
NPI:1336463637
Name:ZIMMERMAN, NICOLE (PSY D)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 REED ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6410
Mailing Address - Country:US
Mailing Address - Phone:507-625-4060
Mailing Address - Fax:507-625-3915
Practice Address - Street 1:600 REED ST
Practice Address - Street 2:SUITE 115
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6410
Practice Address - Country:US
Practice Address - Phone:507-625-4060
Practice Address - Fax:507-625-3915
Is Sole Proprietor?:No
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist