Provider Demographics
NPI:1669053278
Name:PIPKINS, GRACE SPENCER
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:SPENCER
Last Name:PIPKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 SWAN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7127
Mailing Address - Country:US
Mailing Address - Phone:636-696-3640
Mailing Address - Fax:
Practice Address - Street 1:344 SWAN LAKE DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7127
Practice Address - Country:US
Practice Address - Phone:636-696-3640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician