Provider Demographics
NPI:1376346882
Name:TIPKEMPER, AMANDA (MED)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:TIPKEMPER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1154 TEAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2141
Mailing Address - Country:US
Mailing Address - Phone:513-617-3469
Mailing Address - Fax:
Practice Address - Street 1:1154 TEAKWOOD DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2141
Practice Address - Country:US
Practice Address - Phone:513-617-3469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No174400000XOther Service ProvidersSpecialist