Provider Demographics
NPI:1548805070
Name:PIPINICH, CYNTHIA WALKER
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:WALKER
Last Name:PIPINICH
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 1:929 N BUSE ST
Mailing Address - Street 2:
Mailing Address - City:FERGUS FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56537-1132
Mailing Address - Country:US
Mailing Address - Phone:406-580-8736
Mailing Address - Fax:
Practice Address - Street 1:929 N BUSE ST
Practice Address - Street 2:
Practice Address - City:FERGUS FALLS
Practice Address - State:MN
Practice Address - Zip Code:56537-1132
Practice Address - Country:US
Practice Address - Phone:406-580-8736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional