Basic Information
| Provider Information | |||||||||
| NPI: | 1497050504 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIMMERMAN | ||||||||
| FirstName: | CAPRI | ||||||||
| MiddleName: | DANILLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ZIMMERMAN-FRAZIER | ||||||||
| OtherFirstName: | CAPRI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4921 E 21ST STREET N. | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166813204 | ||||||||
| FaxNumber: | 3166810541 | ||||||||
| Practice Location | |||||||||
| Address1: | 4921 E 21ST STREET N | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166813204 | ||||||||
| FaxNumber: | 3166810541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2011 | ||||||||
| LastUpdateDate: | 04/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 1491 | KS | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.