Provider Demographics
NPI:1811879323
Name:ZIMMER, PEGGY (LSC)
Entity type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:LSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 SHOREWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55340-9560
Mailing Address - Country:US
Mailing Address - Phone:763-360-1247
Mailing Address - Fax:
Practice Address - Street 1:611 WALNUT ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4574
Practice Address - Country:US
Practice Address - Phone:612-712-5244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-24
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional