Active NPI
Charlotta P Zimmerman
- Behavior Technician
- Bonne Terre, MO
National Provider Identifier
1720519788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-17-30663
- Practice address
- 136 E School St
Bonne Terre, MO 63628-1724 - Phone
- (636) 232-5894
- Fax
- (314) 845-3901
- NPI assigned
- Mar 22, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-17-30663 | MO | Primary |
Addresses
Primary practice location
136 E School St
Bonne Terre, MO 63628-1724
Mailing address
136 E School St
Bonne Terre, MO 63628-1724
Phone (636) 232-5894
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992256945 | Medicaid | MO |
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
| License | State | Type | Specialty |
|---|---|---|---|
| RBT-17-30663 | MO | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490140800000",
"number": "1720519788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "136 E SCHOOL ST",
"city": "BONNE TERRE",
"state": "MO",
"postal_code": "636281724",
"telephone_number": "636-232-5894",
"fax_number": "314-845-3901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "136 E SCHOOL ST",
"city": "BONNE TERRE",
"state": "MO",
"postal_code": "636281724",
"telephone_number": "636-232-5894",
"fax_number": "314-845-3901"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIMMERMAN",
"first_name": "CHARLOTTA",
"middle_name": "P",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-03-22",
"last_updated": "2017-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MO",
"license": "RBT-17-30663",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1992256945",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bonne Terre, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.