Provider Demographics
NPI:1508156498
Name:LIPPERT, DANIEL JOEL (LADC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:JOEL
Last Name:LIPPERT
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-3271
Mailing Address - Country:US
Mailing Address - Phone:612-326-7600
Mailing Address - Fax:612-326-7636
Practice Address - Street 1:550 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-3271
Practice Address - Country:US
Practice Address - Phone:612-326-7600
Practice Address - Fax:612-326-7636
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302666101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)