Provider Demographics
NPI:1306026067
Name:LIPPS, KAMI JO (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KAMI
Middle Name:JO
Last Name:LIPPS
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MISS
Other - First Name:KAMI
Other - Middle Name:JO
Other - Last Name:RADSEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:575 LESTER AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8695
Mailing Address - Country:US
Mailing Address - Phone:608-783-1452
Mailing Address - Fax:
Practice Address - Street 1:575 LESTER AVE STE 100
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8695
Practice Address - Country:US
Practice Address - Phone:608-783-1452
Practice Address - Fax:608-783-1456
Is Sole Proprietor?:No
Enumeration Date:2007-11-11
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI774-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43736200Medicaid