Provider Demographics
NPI:1679298376
Name:LIPINSKI, KELLY IRENE (CASE MANAGEMENT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:IRENE
Last Name:LIPINSKI
Suffix:
Gender:F
Credentials:CASE MANAGEMENT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:IRENE
Other - Last Name:DUNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASE MANAGEMENT
Mailing Address - Street 1:1515 E TUDOR RD STE 9A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1036
Mailing Address - Country:US
Mailing Address - Phone:832-409-9104
Mailing Address - Fax:907-931-7087
Practice Address - Street 1:1515 E TUDOR RD STE 9A
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1036
Practice Address - Country:US
Practice Address - Phone:832-409-9104
Practice Address - Fax:907-931-7087
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator