Provider Demographics
NPI:1073673836
Name:ZIPPERLE, MARION ISABEL ADELHEID (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARION ISABEL
Middle Name:ADELHEID
Last Name:ZIPPERLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 SANDERS ROAD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:707-527-9960
Mailing Address - Fax:707-823-1342
Practice Address - Street 1:100 E ST STE 306
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4607
Practice Address - Country:US
Practice Address - Phone:707-527-9960
Practice Address - Fax:707-823-1342
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL122030OtherPTAN
CAPSY122030Medicaid