Provider Demographics
NPI:1104429612
Name:ZIMBORSKI, MADDIE MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:MADDIE
Middle Name:MARIE
Last Name:ZIMBORSKI
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:MADDIE
Other - Middle Name:MARIE
Other - Last Name:FAKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:WI
Mailing Address - Zip Code:53185-4165
Mailing Address - Country:US
Mailing Address - Phone:507-698-8091
Mailing Address - Fax:
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-699-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health