Provider Demographics
NPI:1306881867
Name:ZAMMITT, KIMBERLY ANN (PHD, LICSW)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:ZAMMITT
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 LONG ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4397
Mailing Address - Country:US
Mailing Address - Phone:507-625-4884
Mailing Address - Fax:
Practice Address - Street 1:510 LONG ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4397
Practice Address - Country:US
Practice Address - Phone:507-625-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC62781041C0700X
MN187691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06757864Medicaid
MS800000309ZAMMedicare ID - Type Unspecified