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NPI Code Detail

MEDICARE: JOLINE M WIPFF CDP

MEDICARE: JOLINE M WIPFF CDP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorCP60804846WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CP60804846OTHERWADEPARTMENT OF HEALTH

General Provider Information

NPI Number : 1235608571
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOLINE M WIPFF CDP
Provider Business Mailing Address
First Line : 1415 LUMSDEN RD
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98367-9179
Country : US
Telephone Number : 360-876-9430
Fax Number :
Provider Business Practice Location Address
First Line : 1415 LUMSDEN RD
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98367-9179
Country : US
Telephone Number : 360-876-9430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2018
Last Update Date : 10/21/2019

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Directions to “ JOLINE M WIPFF CDP” Practice Location

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