Provider Demographics
NPI:1972940799
Name:DR TAMMY ZIMMEL LLC
Entity type:Organization
Organization Name:DR TAMMY ZIMMEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:262-554-9846
Mailing Address - Street 1:1831 S GREEN BAY RD
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4605
Mailing Address - Country:US
Mailing Address - Phone:262-554-9846
Mailing Address - Fax:262-456-0184
Practice Address - Street 1:1831 S GREEN BAY RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:MT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4605
Practice Address - Country:US
Practice Address - Phone:262-554-9846
Practice Address - Fax:262-456-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty