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NPI Code Detail

MEDICARE: JEZZICA ZIMMERMANN

MEDICARE: JEZZICA ZIMMERMANN
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
1235Z00000XSpeech-Language Pathologist242005412IL

General Provider Information

NPI Number : 1356990204
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEZZICA ZIMMERMANN
Provider Business Mailing Address
First Line : 19049 CENTER AVE
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-4202
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8001 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60620-5930
Country : US
Telephone Number : 773-436-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/04/2019
Last Update Date : 09/04/2019

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Directions to “ JEZZICA ZIMMERMANN ” Practice Location

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