Provider Demographics
NPI:1457718884
Name:TIPPETT, VANESSA JEAN (LAC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:JEAN
Last Name:TIPPETT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:JEAN
Other - Last Name:CRAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, DIPLAC
Mailing Address - Street 1:PO BOX 1571
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-1571
Mailing Address - Country:US
Mailing Address - Phone:715-220-6574
Mailing Address - Fax:715-972-8003
Practice Address - Street 1:8650 US HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9347
Practice Address - Country:US
Practice Address - Phone:715-220-6574
Practice Address - Fax:715-972-8003
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI866-55171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist