Healthcare Provider Details

I. General information

NPI: 1972005866
Provider Name (Legal Business Name): GLENDA KATHRYN LIPPMANN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12265 W BAYAUD AVE STE 235
LAKEWOOD CO
80228-2116
US

IV. Provider business mailing address

12265 W BAYAUD AVE STE 235
LAKEWOOD CO
80228-2116
US

V. Phone/Fax

Practice location:
  • Phone: 303-929-5941
  • Fax:
Mailing address:
  • Phone: 303-929-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPSY3844
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: