Provider Demographics
NPI:1578557385
Name:KNIPP, LIDA LINANNE (LISW)
Entity Type:Individual
Prefix:MRS
First Name:LIDA
Middle Name:LINANNE
Last Name:KNIPP
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7367 CENTRAL COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9742
Mailing Address - Country:US
Mailing Address - Phone:614-855-9200
Mailing Address - Fax:
Practice Address - Street 1:575 COPELAND MILL RD
Practice Address - Street 2:SUITE 1E
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8977
Practice Address - Country:US
Practice Address - Phone:614-848-1920
Practice Address - Fax:614-882-1593
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00038271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKNSW16441Medicare ID - Type Unspecified