Provider Demographics
NPI:1497877690
Name:ZIMMERMAN, WENDY E (EDD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:E
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 W JOPPA ROAD
Mailing Address - Street 2:SUITE 317
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4639
Mailing Address - Country:US
Mailing Address - Phone:410-825-1581
Mailing Address - Fax:410-825-1582
Practice Address - Street 1:2360 W JOPPA ROAD
Practice Address - Street 2:SUITE 317
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4639
Practice Address - Country:US
Practice Address - Phone:410-825-1581
Practice Address - Fax:410-825-1582
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2227103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist