Provider Demographics
NPI:1407863848
Name:ZIMMERMAN, JULIE WALLACE (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:WALLACE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6426 S KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-3948
Mailing Address - Country:US
Mailing Address - Phone:773-241-5000
Mailing Address - Fax:773-241-5000
Practice Address - Street 1:6426 S KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-3948
Practice Address - Country:US
Practice Address - Phone:773-241-5000
Practice Address - Fax:773-241-5000
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632325OtherPSYCHOTHERAPY
IL1632325OtherPSYCHOTHERAPY