Healthcare Provider Details

I. General information

NPI: 1972940799
Provider Name (Legal Business Name): DR TAMMY ZIMMEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2013
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 S GREEN BAY RD SUITE 2B
MT PLEASANT WI
53406-4605
US

IV. Provider business mailing address

1831 S GREEN BAY RD SUITE 2B
MT PLEASANT WI
53406-4605
US

V. Phone/Fax

Practice location:
  • Phone: 262-554-9846
  • Fax: 262-456-0184
Mailing address:
  • Phone: 262-554-9846
  • Fax: 262-456-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: TAMARA L ZIMMEL
Title or Position: OWNER
Credential: PSYD
Phone: 262-554-9846