Provider Demographics
NPI:1629345988
Name:ZIMMERMAN, KORI (MA, LLP)
Entity Type:Individual
Prefix:MISS
First Name:KORI
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49058-1123
Mailing Address - Country:US
Mailing Address - Phone:269-838-0825
Mailing Address - Fax:
Practice Address - Street 1:491 COLUMBIA AVE E STE 4
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49014-5468
Practice Address - Country:US
Practice Address - Phone:269-962-9611
Practice Address - Fax:269-962-9612
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361001841103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist