Provider Demographics
NPI:1891234142
Name:CLIPPERT-TREADWELL, COURTNEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:
Last Name:CLIPPERT-TREADWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 LINCOLN WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-7533
Mailing Address - Country:US
Mailing Address - Phone:515-292-9251
Mailing Address - Fax:844-895-6179
Practice Address - Street 1:3510 LINCOLN WAY STE 300
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-7533
Practice Address - Country:US
Practice Address - Phone:515-292-9251
Practice Address - Fax:844-895-6179
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA076712103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling