Provider Demographics
NPI:1912753781
Name:JIPPING, JOHANNA RENE
Entity Type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:RENE
Last Name:JIPPING
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 1:1 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-3094
Mailing Address - Country:US
Mailing Address - Phone:734-767-2250
Mailing Address - Fax:
Practice Address - Street 1:1 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-3094
Practice Address - Country:US
Practice Address - Phone:734-767-2250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician