MEDICARE: MRS. GERTRUDE CHRISTINE ZIMMERMAN MA LCPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		IL

General Provider Information

NPI Number	:	1053431353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GERTRUDE CHRISTINE ZIMMERMAN MA LCPC

Provider Business Mailing Address
First Line	:	927 SANTA ROSA AVE
Second Line	:
City	:	WHEATON
State	:	IL
Zip	:	60187-3826
Country	:	US
Telephone Number	:	630-681-1850
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 WEST WESLEY ST
Second Line	:	SUITE 204
City	:	WHEATON
State	:	IL
Zip	:	60187-5102
Country	:	US
Telephone Number	:	630-681-1850
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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