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NPI Code Detail

MEDICARE: JACOB ZIMMER CDCA

MEDICARE: JACOB ZIMMER CDCA
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
1101YA0400XAddiction (Substance Use Disorder) CounselorCDCA.183171OH

General Provider Information

NPI Number : 1326741182
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACOB ZIMMER CDCA
Provider Business Mailing Address
First Line : 682 HAWTHORNE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45205
Country : US
Telephone Number : 513-257-4964
Fax Number :
Provider Business Practice Location Address
First Line : 682 HAWTHORNE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45205-2398
Country : US
Telephone Number : 513-212-4262
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/22/2023
Last Update Date : 03/22/2023

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Directions to “ JACOB ZIMMER CDCA” Practice Location

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