MEDICARE: MR. KENNETH CARL ZIMMERMAN LISW

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	104100000X	Social Worker	00049	IA

General Provider Information

NPI Number	:	1356358949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH CARL ZIMMERMAN LISW

Provider Business Mailing Address
First Line	:	PO BOX 379
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50402-0379
Country	:	US
Telephone Number	:	641-512-5565
Fax Number	:	641-512-5565

Provider Business Practice Location Address
First Line	:	1522 6TH ST SW
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-4820
Country	:	US
Telephone Number	:	641-512-5565
Fax Number	:	641-512-5565

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	06/23/2008

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