Provider Demographics
NPI:1831131911
Name:ZIMMERMAN, SEPHANIE M (PHD)
Entity Type:Individual
Prefix:
First Name:SEPHANIE
Middle Name:M
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 N CABLE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-1739
Mailing Address - Country:US
Mailing Address - Phone:419-222-1029
Mailing Address - Fax:
Practice Address - Street 1:940 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-1748
Practice Address - Country:US
Practice Address - Phone:419-222-1029
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1440103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0256333Medicaid
OH0256333Medicaid