Provider Demographics
NPI:1487678033
Name:TIPTON, DWAINE DALE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:DWAINE
Middle Name:DALE
Last Name:TIPTON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 BROCKWELL DR
Mailing Address - Street 2:
Mailing Address - City:DARDENNE PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8370
Mailing Address - Country:US
Mailing Address - Phone:314-779-7040
Mailing Address - Fax:
Practice Address - Street 1:10094 LITZSINGER RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1132
Practice Address - Country:US
Practice Address - Phone:314-989-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20050052031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical