Provider Demographics
NPI:1952841686
Name:ZIMMERMAN, FRANK (BA)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 RIVER LN
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-5041
Mailing Address - Country:US
Mailing Address - Phone:815-703-9932
Mailing Address - Fax:
Practice Address - Street 1:6816 N 2ND ST
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-3704
Practice Address - Country:US
Practice Address - Phone:815-877-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral