MEDICARE: REBECCA J ZIMMERMAN LMSW

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	6685	ND

General Provider Information

NPI Number	:	1770346264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA J ZIMMERMAN LMSW

Provider Business Mailing Address
First Line	:	602 BELMONT RD
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-4908
Country	:	US
Telephone Number	:	505-239-9376
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 S WASHINGTON ST STE C
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-6339
Country	:	US
Telephone Number	:	757-142-5701
Fax Number	:

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

Provider Enumeration Date	:	02/06/2024
Last Update Date	:	02/09/2024

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