=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437380565
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACOB WALTER ZIMMER MSW,LSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/06/2009
-----------------------------------------------------
Last Update Date | 04/29/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3325 GLENMORE AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-233-4852
-----------------------------------------------------
Fax | 513-471-4732
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3325 GLENMORE AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45211-6510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-233-4852
-----------------------------------------------------
Fax | 513-471-4732
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------