Provider Demographics
NPI:1053431353
Name:ZIMMERMAN, GERTRUDE CHRISTINE (MA LCPC)
Entity type:Individual
Prefix:MRS
First Name:GERTRUDE
Middle Name:CHRISTINE
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MA LCPC
Other - Prefix:
Other - First Name:TRUDY
Other - Middle Name:
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA LCPC
Mailing Address - Street 1:927 SANTA ROSA AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3826
Mailing Address - Country:US
Mailing Address - Phone:630-681-1850
Mailing Address - Fax:
Practice Address - Street 1:213 WEST WESLEY ST
Practice Address - Street 2:SUITE 204
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5102
Practice Address - Country:US
Practice Address - Phone:630-681-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional