Provider Demographics
NPI:1659474070
Name:ZIMMERMAN, CARLA MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 E NORA ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-1572
Mailing Address - Country:US
Mailing Address - Phone:480-798-8556
Mailing Address - Fax:
Practice Address - Street 1:4700 S MCCLINTOCK DR STE 135
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7375
Practice Address - Country:US
Practice Address - Phone:602-919-2068
Practice Address - Fax:602-224-2460
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0024235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01026746OtherASHA I.D. NUMBER
AZSLP0024OtherSTATE LICENSE