Provider Demographics
NPI:1720561012
Name:WIPF, MEREDITH ANN (PLMHP, PCMSW)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANN
Last Name:WIPF
Suffix:
Gender:F
Credentials:PLMHP, PCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5619 S 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-3601
Mailing Address - Country:US
Mailing Address - Phone:531-299-8862
Mailing Address - Fax:
Practice Address - Street 1:5619 S 19TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-3601
Practice Address - Country:US
Practice Address - Phone:531-299-8862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112261041S0200X
NE71691041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool