Healthcare Provider Details

I. General information

NPI: 1720804636
Provider Name (Legal Business Name): ASHLEY ANN ZIMMER-LARSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2333 W 57TH ST STE 103
SIOUX FALLS SD
57108-5054
US

IV. Provider business mailing address

2333 W 57TH ST STE 103
SIOUX FALLS SD
57108-5054
US

V. Phone/Fax

Practice location:
  • Phone: 605-271-5640
  • Fax:
Mailing address:
  • Phone: 605-271-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-MH-30862
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number24-869
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: