Provider Demographics
NPI:1154461184
Name:TIPPETT, DONNA CLARK (MPH, MA, CCC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:CLARK
Last Name:TIPPETT
Suffix:
Gender:F
Credentials:MPH, MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MONTROSE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5611
Mailing Address - Country:US
Mailing Address - Phone:410-955-7895
Mailing Address - Fax:410-955-9792
Practice Address - Street 1:601 N. CAROLINE STREET
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0910
Practice Address - Country:US
Practice Address - Phone:410-955-7895
Practice Address - Fax:410-955-9792
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01415235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist