Provider Demographics
NPI:1356820765
Name:ZIMMERMANN, RONIQUA TESHAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RONIQUA
Middle Name:TESHAE
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RONIQUA
Other - Middle Name:TESHAE
Other - Last Name:ROUNDTREE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:53174 FLOWING STREAM CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-9034
Mailing Address - Country:US
Mailing Address - Phone:708-927-4042
Mailing Address - Fax:
Practice Address - Street 1:53174 FLOWING STREAM CT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-9034
Practice Address - Country:US
Practice Address - Phone:708-927-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
IN34008856A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor