Provider Demographics
NPI:1629184338
Name:ZIEMER, MARTY J (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARTY
Middle Name:J
Last Name:ZIEMER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 BEHM DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-1407
Mailing Address - Country:US
Mailing Address - Phone:847-223-7818
Mailing Address - Fax:
Practice Address - Street 1:349 BEHM DR
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-1407
Practice Address - Country:US
Practice Address - Phone:847-223-7818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health