Provider Demographics
NPI:1912958646
Name:DIPPEL, RAYE LYNNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAYE
Middle Name:LYNNE
Last Name:DIPPEL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 PARKVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-1629
Mailing Address - Country:US
Mailing Address - Phone:719-635-3453
Mailing Address - Fax:719-635-3453
Practice Address - Street 1:1830 PARKVIEW BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-1629
Practice Address - Country:US
Practice Address - Phone:719-635-3453
Practice Address - Fax:719-635-3453
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82106Medicare ID - Type Unspecified