Provider Demographics
NPI:1932812955
Name:TIPERT, LAUREL E
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:E
Last Name:TIPERT
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 1:6133 ROCKEFELLER AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8215
Mailing Address - Country:US
Mailing Address - Phone:214-995-6826
Mailing Address - Fax:
Practice Address - Street 1:6133 ROCKEFELLER AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8215
Practice Address - Country:US
Practice Address - Phone:214-995-6826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician