Provider Demographics
NPI:1790476877
Name:ZIMMERMAN, SANDY JOANN
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:JOANN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:JOANN
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA183649
Mailing Address - Street 1:8308 OHIO RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-1714
Mailing Address - Country:US
Mailing Address - Phone:740-529-1201
Mailing Address - Fax:740-876-8854
Practice Address - Street 1:8308 OHIO RIVER RD
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-1714
Practice Address - Country:US
Practice Address - Phone:740-529-1201
Practice Address - Fax:740-876-8854
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.183649101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)