Provider Demographics
NPI:1336339019
Name:KIPPEN, JULIA EVALYNE (LMSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:EVALYNE
Last Name:KIPPEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 PANCHERI DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3344
Mailing Address - Country:US
Mailing Address - Phone:208-552-6900
Mailing Address - Fax:208-552-4973
Practice Address - Street 1:808 PANCHERI DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3344
Practice Address - Country:US
Practice Address - Phone:208-552-6900
Practice Address - Fax:208-552-4973
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-28125104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker