Provider Demographics
NPI:1083593644
Name:ZIMMERMAN, MELISSA MARIE (SUDPT)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:MARIE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:PERNICIARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SUDPT
Mailing Address - Street 1:17503 25TH AVE NE UNIT P107
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98271-4845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2322 196TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7010
Practice Address - Country:US
Practice Address - Phone:425-984-0788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO6152115101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty