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NPI Code Detail

MEDICARE: KATIE ZIMMER LCSW

MEDICARE: KATIE ZIMMER LCSW
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
11041C0700XClinical Social Worker5240CAL
21041C0700XClinical Social Worker10625-CNV

General Provider Information

NPI Number : 1255718326
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATIE ZIMMER LCSW
Provider Business Mailing Address
First Line : 4485 S BUFFALO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-5006
Country : US
Telephone Number : 702-485-1259
Fax Number :
Provider Business Practice Location Address
First Line : 4485 S BUFFALO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89147-5006
Country : US
Telephone Number : 702-485-1259
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2015
Last Update Date : 08/30/2023

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Directions to “ KATIE ZIMMER LCSW” Practice Location

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