Provider Demographics
NPI:1477888634
Name:TEKIPPE, PAMELA SUE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:SUE
Last Name:TEKIPPE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:PAXSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:1309 S BROADWAY ST
Mailing Address - Street 2:PO BOX 7
Mailing Address - City:TOLEDO
Mailing Address - State:IA
Mailing Address - Zip Code:52342-2307
Mailing Address - Country:US
Mailing Address - Phone:641-484-5234
Mailing Address - Fax:641-484-5632
Practice Address - Street 1:1309 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:IA
Practice Address - Zip Code:52342-2307
Practice Address - Country:US
Practice Address - Phone:641-484-5234
Practice Address - Fax:641-484-5632
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA013161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164527248OtherWELLMARK BLUE CROSS/BLUE SHIELD
IA0031484Medicaid
IA0031484Medicaid