Provider Demographics
NPI:1659085918
Name:ZIMMERMAN, MADISON ANN (LAC, NCC)
Entity Type:Individual
Prefix:MISS
First Name:MADISON
Middle Name:ANN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 N BOYD RD
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-8997
Mailing Address - Country:US
Mailing Address - Phone:480-272-1046
Mailing Address - Fax:
Practice Address - Street 1:1017 S GILBERT RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-4442
Practice Address - Country:US
Practice Address - Phone:602-363-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health