Provider Demographics
NPI:1518335231
Name:ZIMMERMAN, REVA M (PHD, SLP-CCC)
Entity Type:Individual
Prefix:
First Name:REVA
Middle Name:M
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PHD, SLP-CCC
Other - Prefix:
Other - First Name:REVA
Other - Middle Name:
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-CCC
Mailing Address - Street 1:201 CARTER DR STE 418
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-4998
Mailing Address - Country:US
Mailing Address - Phone:610-436-2588
Mailing Address - Fax:
Practice Address - Street 1:201 CARTER DR STE 418
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4998
Practice Address - Country:US
Practice Address - Phone:610-436-2588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-11
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL15933235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist