Provider Demographics
NPI:1770242125
Name:ZIMMERMAN, IAN
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-4280
Mailing Address - Country:US
Mailing Address - Phone:615-823-4041
Mailing Address - Fax:866-936-1472
Practice Address - Street 1:630 PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-4280
Practice Address - Country:US
Practice Address - Phone:615-823-4041
Practice Address - Fax:866-936-1472
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst