MEDICARE: DR. TAMMY LYNN ZIMMEL PSYD

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	103TC0700X	Clinical Psychologist	2225-057	WI

General Provider Information

NPI Number	:	1134288392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMMY LYNN ZIMMEL PSYD

Provider Business Mailing Address
First Line	:	1135 N GREEN BAY RD
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53406-3501
Country	:	US
Telephone Number	:	262-636-9920
Fax Number	:	262-598-9023

Provider Business Practice Location Address
First Line	:	3701 DURAND AVE
Second Line	:	SUITE 325
City	:	RACINE
State	:	WI
Zip	:	53405-4458
Country	:	US
Telephone Number	:	262-554-9846
Fax Number	:	262-598-9032

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	07/08/2007

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