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NPI Code Detail

MEDICARE: KRISTEN WIPPERMANN

MEDICARE: KRISTEN WIPPERMANN
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
1103K00000XBehavior Analyst11621917IN

General Provider Information

NPI Number : 1417311614
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN WIPPERMANN
Provider Business Mailing Address
First Line : 1061 E SOUTHERN AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-5214
Country : US
Telephone Number : 463-701-0909
Fax Number : 640-500-3096
Provider Business Practice Location Address
First Line : 1061 E SOUTHERN AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-5214
Country : US
Telephone Number : 463-701-0909
Fax Number : 640-500-3096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2016
Last Update Date : 11/09/2023

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Directions to “ KRISTEN WIPPERMANN ” Practice Location

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