Healthcare Provider Details

I. General information

NPI: 1164546891
Provider Name (Legal Business Name): LINDA LOU TIPPEY M.A., L.C.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 WINDISH DR
GALESBURG IL
61401-9780
US

IV. Provider business mailing address

1115 FLORENCE AVE
GALESBURG IL
61401-2946
US

V. Phone/Fax

Practice location:
  • Phone: 309-344-4374
  • Fax: 309-344-4281
Mailing address:
  • Phone: 309-344-4200
  • Fax: 309-344-4281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-001076
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: