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General NPI Number Information
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NPI Number | 1962745885
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Entity Type | Individual
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Provider Name | SCOTT KISER ZIMBER LCPC
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Gender | Male
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 05/06/2013
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Provider Practice Location Address
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Address Line | 7315 N ALPINE RD STE H
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City | LOVES PARK
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State | IL
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Zip | 61111-1804
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Country | US
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Telephone | 815-621-2398
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Fax | 815-654-9728
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Provider Business Mailing Address
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Address Line | 4558 BURNINGTREE DR
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City | ROCKFORD
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State | IL
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Zip | 61114-5306
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Country | US
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Telephone | 815-621-2398
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Fax | 815-654-9728
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.008583
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License Number State | IL
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