Provider Demographics
NPI:1053588293
Name:ZIMMERMAN, JOANNE (MA, OTR)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MA, OTR
Other - Prefix:MS
Other - First Name:JOANNE
Other - Middle Name:ZIMMERMAN
Other - Last Name:GREBNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA,OTR
Mailing Address - Street 1:9455 W WATERTOWN PLANK RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3559
Mailing Address - Country:US
Mailing Address - Phone:414-257-7318
Mailing Address - Fax:
Practice Address - Street 1:9455 W WATERTOWN PLANK RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3559
Practice Address - Country:US
Practice Address - Phone:414-257-7318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1977-026283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40749700Medicaid