Healthcare Provider Details

I. General information

NPI: 1972835825
Provider Name (Legal Business Name): CYNTHIA ZIMMERMAN MS PPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N 4TH ST STE 103
LARAMIE WY
82072-2091
US

IV. Provider business mailing address

1773 RIVERSIDE DR
LARAMIE WY
82070-6625
US

V. Phone/Fax

Practice location:
  • Phone: 307-399-9191
  • Fax: 307-399-9191
Mailing address:
  • Phone: 307-399-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-1400
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number1400
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: