Provider Demographics
NPI:1437750056
Name:ZIMMERMAN, TANNER (MA)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 SILVER BELL RD APT 105
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1197
Mailing Address - Country:US
Mailing Address - Phone:608-498-8494
Mailing Address - Fax:
Practice Address - Street 1:1887 SILVER BELL RD APT 105
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1197
Practice Address - Country:US
Practice Address - Phone:608-498-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist