Provider Demographics
NPI:1568076198
Name:ZIMMERMAN, AMY D'LIGHT
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:D'LIGHT
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8285 SW NIMBUS AVE STE 148
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6465
Mailing Address - Country:US
Mailing Address - Phone:503-352-3260
Mailing Address - Fax:503-352-3262
Practice Address - Street 1:8285 SW NIMBUS AVE STE 148
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6465
Practice Address - Country:US
Practice Address - Phone:503-352-3260
Practice Address - Fax:503-352-3262
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA125161041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical