Provider Demographics
NPI:1003776725
Name:ZIMMERMAN, ISAAC ROBERT
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:ROBERT
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7332 183RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579-8734
Mailing Address - Country:US
Mailing Address - Phone:360-508-5300
Mailing Address - Fax:
Practice Address - Street 1:1415 HARRISON AVE NW STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5359
Practice Address - Country:US
Practice Address - Phone:360-605-0163
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician