Provider Demographics
NPI:1215103924
Name:ZIMMERMANN, CHRISTINE M (CSAC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:M
Last Name:ZIMMERMANN
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 S 17TH AVENUE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095
Mailing Address - Country:US
Mailing Address - Phone:262-306-4392
Mailing Address - Fax:262-306-6740
Practice Address - Street 1:279 S 17TH AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3001
Practice Address - Country:US
Practice Address - Phone:262-306-4392
Practice Address - Fax:262-306-6740
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14389-132101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)