Provider Demographics
NPI:1366880122
Name:ZIMMERMAN, KEVIN JOHN (MS, LMFT, CFLE)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JOHN
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MS, LMFT, CFLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 AIRPORT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8231
Mailing Address - Country:US
Mailing Address - Phone:515-441-9397
Mailing Address - Fax:
Practice Address - Street 1:1525 AIRPORT RD STE 101
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8231
Practice Address - Country:US
Practice Address - Phone:515-441-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000406106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist