Provider Demographics
NPI:1881085132
Name:WIPPLER, SHAWNA JO (CPRP)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:JO
Last Name:WIPPLER
Suffix:
Gender:F
Credentials:CPRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 INDUSTRIAL PARK RD SW
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-8338
Mailing Address - Country:US
Mailing Address - Phone:218-829-7599
Mailing Address - Fax:218-829-7498
Practice Address - Street 1:1021 INDUSTRIAL PARK RD SW
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-8338
Practice Address - Country:US
Practice Address - Phone:218-829-7599
Practice Address - Fax:218-829-7498
Is Sole Proprietor?:No
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4911780101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health