Provider Demographics
NPI:1265091060
Name:TIPPETTS, STEPHEN (MSW, CSW)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:TIPPETTS
Suffix:
Gender:M
Credentials:MSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E 4200 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3040
Mailing Address - Country:US
Mailing Address - Phone:801-349-6859
Mailing Address - Fax:
Practice Address - Street 1:5175 S PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-4932
Practice Address - Country:US
Practice Address - Phone:801-264-7434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical