Child Therapy Lab LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

CHILD THERAPY LAB LLC

Practice address

53174 Flowing Stream CT
South Bend, IN 46628-9034

Phone

(317) 662-4403

Fax

(317) 900-1896

NPI assigned

Aug 6, 2021

Last updated

Aug 6, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Roniqua Teshae Zimmermann, LCSWNPI 1356820765

Title

Owner/Director

Phone

(317) 662-4403

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Roniqua Teshae Zimmermann, LCSW

  • Clinical Social Worker
  • South Bend, IN
  • NPI 1356820765
  NPD Authorized official

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

{
    "created_epoch": "1628208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1952075574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53174 FLOWING STREAM CT",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466289034",
            "telephone_number": "317-662-4403",
            "fax_number": "317-900-1896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53174 FLOWING STREAM CT",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466289034",
            "telephone_number": "317-662-4403",
            "fax_number": "317-900-1896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILD THERAPY LAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-06",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMANN",
        "authorized_official_first_name": "RONIQUA",
        "authorized_official_middle_name": "TESHAE",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "317-662-4403",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel William Chettleburgh, OTR
• April Christine Chew, DNP, APRN, FNP-BC
• David CHI, MD
• Chimwemwe Chigamba
• Rebecca Ann Chilcote
• Children's Therapy Innovations Inc. (CTI Aging and Rehabilitative Services)
• Chiropractic Health Center, PC
• Chiropractic Health Center, PC
• Larissa M. Chism Buggs, MD
• Hibajene Chisonga

• Clinical Social Worker in South Bend, IN
• Providers in South Bend, IN by specialty
• Clinical Social Worker in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2021; 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.