Basic Information
| Provider Information | |||||||||
| NPI: | 1003294729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMMER | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2680 VERNON DR | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543045374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9202721200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2680 VERNON DR | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543045374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9205170044 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2015 | ||||||||
| LastUpdateDate: | 10/29/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | WI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.