Provider Demographics
NPI:1578612289
Name:ZIMMERMAN, JUDITH CARROLL (MA,LMFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CARROLL
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MA,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 TERRACE DR
Mailing Address - Street 2:#206
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1797
Mailing Address - Country:US
Mailing Address - Phone:651-699-5105
Mailing Address - Fax:
Practice Address - Street 1:7954 UNIVERSITY AVE NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-1860
Practice Address - Country:US
Practice Address - Phone:763-780-3036
Practice Address - Fax:763-780-0784
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical