Provider Demographics
NPI:1770346264
Name:ZIMMERMAN, REBECCA J (LMSW)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:602 BELMONT RD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4908
Mailing Address - Country:US
Mailing Address - Phone:505-239-9376
Mailing Address - Fax:
Practice Address - Street 1:1913 S WASHINGTON ST STE C
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6339
Practice Address - Country:US
Practice Address - Phone:757-142-5701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND6685104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker