Healthcare Provider Details

I. General information

NPI: 1013799741
Provider Name (Legal Business Name): ANNABEL ELAINE ZIMMER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2023
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4812 SANTANA CIR
COLUMBIA MO
65203-7138
US

IV. Provider business mailing address

2301 PRIMROSE DR APT 6C
COLUMBIA MO
65202-1207
US

V. Phone/Fax

Practice location:
  • Phone: 573-514-3525
  • Fax:
Mailing address:
  • Phone: 660-349-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number2023027928
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: