Provider Demographics
NPI:1184653917
Name:HIPPE, DOUGLAS (PHD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:HIPPE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12805 W 100TH TER
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-1703
Mailing Address - Country:US
Mailing Address - Phone:913-271-7899
Mailing Address - Fax:913-894-1329
Practice Address - Street 1:12805 W 100TH TER
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-1703
Practice Address - Country:US
Practice Address - Phone:913-271-7899
Practice Address - Fax:913-894-1329
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100237650BMedicaid
KSKA2394Medicare PIN
KSKA1635Medicare PIN