MEDICARE: CARLA MARIE ZIMMERMAN CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLP0024	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01026746	OTHER		ASHA I.D. NUMBER
2	SLP0024	OTHER	AZ	STATE LICENSE

General Provider Information

NPI Number	:	1659474070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA MARIE ZIMMERMAN CCC-SLP

Provider Business Mailing Address
First Line	:	2340 E NORA ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-1572
Country	:	US
Telephone Number	:	480-798-8556
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 S MCCLINTOCK DR STE 135
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-7375
Country	:	US
Telephone Number	:	602-919-2068
Fax Number	:	602-224-2460

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	08/27/2020

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