Healthcare Provider Details

I. General information

NPI: 1568781649
Provider Name (Legal Business Name): MICHELLE ZIMMERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 N 67TH AVE
PHOENIX AZ
85033-4517
US

IV. Provider business mailing address

14330 N 146TH LN
SURPRISE AZ
85379-4715
US

V. Phone/Fax

Practice location:
  • Phone: 623-691-4085
  • Fax:
Mailing address:
  • Phone: 602-410-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLPL7578
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: