Provider Demographics
NPI:1225147093
Name:LIPPMAN, JESSICA G (PHD)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:G
Last Name:LIPPMAN
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 1:600 NORTH MCCLURG COURT
Mailing Address - Street 2:1210A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-337-6797
Mailing Address - Fax:312-337-5572
Practice Address - Street 1:600 NORTH MCCLURG COURT
Practice Address - Street 2:1210A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-337-6797
Practice Address - Fax:312-337-5572
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071002997103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
200488Medicare ID - Type Unspecified