Provider Demographics
NPI:1629519442
Name:ZIEMBA, AMANDA (MT-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:ZIEMBA
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3713
Mailing Address - Country:US
Mailing Address - Phone:845-425-9708
Mailing Address - Fax:
Practice Address - Street 1:2130 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3026
Practice Address - Country:US
Practice Address - Phone:845-425-9708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-13
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist