Provider Demographics
NPI:1467831586
Name:ZIMMERMAN, RITA (MS)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MEDICAL DR
Mailing Address - Street 2:SUITE D 101
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4946
Mailing Address - Country:US
Mailing Address - Phone:801-683-1062
Mailing Address - Fax:801-295-5537
Practice Address - Street 1:415 MEDICAL DR
Practice Address - Street 2:SUITE D 101
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-4946
Practice Address - Country:US
Practice Address - Phone:801-683-1062
Practice Address - Fax:801-295-5537
Is Sole Proprietor?:No
Enumeration Date:2015-05-21
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8208797-6004101YM0800X
UT72153103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool