Healthcare Provider Details

I. General information

NPI: 1548251655
Provider Name (Legal Business Name): GLENN ZIPPERER LCSW CADC III
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W MAIN ST STE 350
PORT WASHINGTON WI
53074-1813
US

IV. Provider business mailing address

PO BOX 994 STE 350
PORT WASHINGTON WI
53074-0994
US

V. Phone/Fax

Practice location:
  • Phone: 262-284-8130
  • Fax: 262-284-8130
Mailing address:
  • Phone: 262-284-8130
  • Fax: 262-284-8104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1105
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2320123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: