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NPI Code Detail

MEDICARE: MRS. NICOLE GRIFFIN LIPOWSKI BCBA

MEDICARE: MRS. NICOLE GRIFFIN LIPOWSKI BCBA
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
1174400000XSpecialist051073736GA
2222Q00000XDevelopmental TherapistMG50380121PIL
3103K00000XBehavior Analyst1-19-36585

General Provider Information

NPI Number : 1437697083
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NICOLE GRIFFIN LIPOWSKI BCBA
Provider Business Mailing Address
First Line : 8223 W 141ST ST
Second Line :
City : ORLAND PARK
State : IL
Zip : 60462-2323
Country : US
Telephone Number : 912-690-5735
Fax Number :
Provider Business Practice Location Address
First Line : 24 JOE KENNEDY BLVD STE 13
Second Line :
City : STATESBORO
State : GA
Zip : 30458-3113
Country : US
Telephone Number : 912-208-2024
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2017
Last Update Date : 05/28/2024

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