Provider Demographics
NPI:1437380565
Name:ZIMMER, JACOB WALTER (MSW,LSW)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:WALTER
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 GLENMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-6510
Mailing Address - Country:US
Mailing Address - Phone:513-233-4852
Mailing Address - Fax:513-471-4732
Practice Address - Street 1:3325 GLENMORE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211
Practice Address - Country:US
Practice Address - Phone:513-233-4852
Practice Address - Fax:513-471-4732
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0285886Medicaid