Provider Demographics
NPI:1841410453
Name:LIPPERT, CHARLES L (LMP)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:L
Last Name:LIPPERT
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 MISSION AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CASHMERE
Mailing Address - State:WA
Mailing Address - Zip Code:98815-1609
Mailing Address - Country:US
Mailing Address - Phone:509-782-8011
Mailing Address - Fax:
Practice Address - Street 1:203 MISSION AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815-1609
Practice Address - Country:US
Practice Address - Phone:509-782-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00008362174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist