Individual provider Active NPI

Kylie Aine Zimmerman, LMFT-IT

  • Marriage & Family Therapist
  • Oshkosh, WI
National Provider Identifier
1417718685
Registry record updated Jan 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
1024-228 Issued in WI
Practice address
2211 Oregon St Ste N
Oshkosh, WI 54902-7001
Phone
(920) 479-1996
Fax
(920) 479-1997
NPI assigned
Jan 16, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 1024-228 WI Primary

Addresses

Primary practice location

2211 Oregon St Ste N
Oshkosh, WI 54902-7001

Mailing address

437 Ruggles St
Fond Du Lac, WI 54935-3929
Phone (920) 344-8438

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1024-228WIMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Oshkosh Marriage and Family Therapy Center, LLC Marriage & Family Therapist CurrentSince Jan 21, 2024 Accepting new patients
Rawhide Inc. Past Accepting new patients

Locations

2211 Oregon St
Ste N
Oshkosh, WI 54902
Phone (920) 479-1996

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1705363200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1417718685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 RUGGLES ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353929",
            "telephone_number": "920-344-8438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2211 OREGON ST STE N",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549027001",
            "telephone_number": "920-479-1996",
            "fax_number": "920-479-1997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIMMERMAN",
        "first_name": "KYLIE",
        "middle_name": "AINE",
        "credential": "LMFT-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-16",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "WI",
            "license": "1024-228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oshkosh, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.