Provider Demographics
NPI:1811035843
Name:ZIMMER, JOEY MARIE (MS-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JOEY
Middle Name:MARIE
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:MISS
Other - First Name:JOEY
Other - Middle Name:MARIE
Other - Last Name:WIESEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MC-CCC-SLP
Mailing Address - Street 1:15955 NEW HALLS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-1227
Mailing Address - Country:US
Mailing Address - Phone:618-259-1319
Mailing Address - Fax:
Practice Address - Street 1:15955 NEW HALLS FERRY RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-1227
Practice Address - Country:US
Practice Address - Phone:618-259-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist