Provider Demographics
NPI:1255718326
Name:ZIMMER, KATIE (LCSW)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 S BUFFALO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-5006
Mailing Address - Country:US
Mailing Address - Phone:702-485-1259
Mailing Address - Fax:
Practice Address - Street 1:4485 S BUFFALO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-5006
Practice Address - Country:US
Practice Address - Phone:702-485-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5240C1041C0700X
NV10625-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical