Provider Demographics
NPI:1417574377
Name:LIPPHARDT, LAUREN ANN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:LIPPHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US DOMESTIC
Mailing Address - Street 2:5 REVERE DR SUITE 120
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8008 E ARAPAHOE CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6839
Practice Address - Country:US
Practice Address - Phone:844-247-7222
Practice Address - Fax:847-584-2604
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-20-45375103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst