Provider Demographics
NPI:1275084931
Name:LIPINSKI, JOHN (HIS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LIPINSKI
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 HAMPTON VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2127
Mailing Address - Country:US
Mailing Address - Phone:314-481-6005
Mailing Address - Fax:314-481-4272
Practice Address - Street 1:237 E CENTER DR STE A
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5995
Practice Address - Country:US
Practice Address - Phone:618-208-3250
Practice Address - Fax:618-208-3261
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3287237700000X
MO2008009334237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist