Provider Demographics
NPI:1255488912
Name:STIPP, ELISABETH DANIELLE (LMP)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:DANIELLE
Last Name:STIPP
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33650 6TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6754
Mailing Address - Country:US
Mailing Address - Phone:253-942-3303
Mailing Address - Fax:253-815-8805
Practice Address - Street 1:33650 6TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6754
Practice Address - Country:US
Practice Address - Phone:253-942-3303
Practice Address - Fax:253-815-8805
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00019206174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist