Provider Demographics
NPI:1649511528
Name:PHIPPS, DELLLA MAE (PC)
Entity type:Individual
Prefix:MRS
First Name:DELLLA
Middle Name:MAE
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8025 EXCELSIOR DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1900
Mailing Address - Country:US
Mailing Address - Phone:608-663-6154
Mailing Address - Fax:
Practice Address - Street 1:8025 EXCELSIOR DR
Practice Address - Street 2:SUITE 110
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1900
Practice Address - Country:US
Practice Address - Phone:608-663-6154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-03
Last Update Date:2013-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1609 - 226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional