Provider Demographics
NPI:1447557665
Name:SHIPOWICK, JUSTIN (LICSW)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SHIPOWICK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 WILLOW CREEK RD STE A101-142
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1673
Mailing Address - Country:US
Mailing Address - Phone:866-225-0605
Mailing Address - Fax:206-536-3965
Practice Address - Street 1:721 DEPOT DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-1615
Practice Address - Country:US
Practice Address - Phone:866-225-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW601882441041C0700X
AZLCSW193501041C0700X
AK11431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1719531Medicaid
WA2231196Medicaid