Healthcare Provider Details

I. General information

NPI: 1336751189
Provider Name (Legal Business Name): AMANDA ZIMMERMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20535 MACK AVE
GROSSE POINTE WOODS MI
48236-1655
US

IV. Provider business mailing address

24230 EASTWOOD ST
OAK PARK MI
48237-1602
US

V. Phone/Fax

Practice location:
  • Phone: 312-882-1024
  • Fax: 312-488-3663
Mailing address:
  • Phone: 708-606-4485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401003381
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: