Provider Demographics
NPI:1629119664
Name:ZIMMERMAN, JAMIE N (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:N
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 SHERIFF DIERKER CT
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2468
Mailing Address - Country:US
Mailing Address - Phone:636-978-7785
Mailing Address - Fax:636-978-7885
Practice Address - Street 1:105 SHERIFF DIERKER CT
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2468
Practice Address - Country:US
Practice Address - Phone:636-978-7785
Practice Address - Fax:636-978-7885
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003001996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO466034402Medicaid