Provider Demographics
NPI:1497050504
Name:ZIMMERMAN, CAPRI DANILLE (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAPRI
Middle Name:DANILLE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:CAPRI
Other - Middle Name:
Other - Last Name:ZIMMERMAN-FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4921 E 21ST STREET N.
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208
Mailing Address - Country:US
Mailing Address - Phone:316-681-3204
Mailing Address - Fax:316-681-0541
Practice Address - Street 1:4921 E 21ST STREET N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208
Practice Address - Country:US
Practice Address - Phone:316-681-3204
Practice Address - Fax:316-681-0541
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist