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General NPI Number Information
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NPI Number | 1578612289
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Entity Type | Individual
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Provider Name | JUDITH CARROLL ZIMMERMAN MA,LMFT
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Gender | Female
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 10/29/2008
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Provider Practice Location Address
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Address Line | 7954 UNIVERSITY AVE NE
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City | FRIDLEY
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State | MN
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Zip | 55432-1860
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Country | US
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Telephone | 763-780-3036
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Fax | 763-780-0784
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Provider Business Mailing Address
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Address Line | 1360 TERRACE DR #206
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City | ROSEVILLE
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State | MN
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Zip | 55113-1797
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Country | US
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Telephone | 651-699-5105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1233
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License Number State | MN
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