Provider Demographics
NPI:1922581388
Name:LIPPENCOTT, LAURA ANN (LSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:LIPPENCOTT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ANN
Other - Last Name:ECKELBARGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:15 E PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-2201
Mailing Address - Country:US
Mailing Address - Phone:937-325-5564
Mailing Address - Fax:
Practice Address - Street 1:15 E PLEASANT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-2201
Practice Address - Country:US
Practice Address - Phone:937-325-5564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31-0577663Medicaid