Provider Demographics
NPI:1972244291
Name:FLIPPEN, HEIDE L
Entity Type:Individual
Prefix:
First Name:HEIDE
Middle Name:L
Last Name:FLIPPEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 W SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83703-4725
Mailing Address - Country:US
Mailing Address - Phone:208-340-0930
Mailing Address - Fax:
Practice Address - Street 1:3500 W SCENIC DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83703-4725
Practice Address - Country:US
Practice Address - Phone:208-340-0930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-02
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDEDUID552776347103TS0200X
WA439884H103TS0200X
ID34419103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
34419OtherNATIONAL CERTIFIED SCHOOL PSYCHOLOGIST
IDEDUID552776347OtherEDUCATIONAL CERTIFICATE/ LICENSE
WA439884HOtherEDUCATIONAL CERTIFICATE/ LICENSE