Healthcare Provider Details

I. General information

NPI: 1013130517
Provider Name (Legal Business Name): JANE L. TIPPET PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CLAFLIN RD
MANHATTAN KS
66502-3415
US

IV. Provider business mailing address

2001 CLAFLIN RD
MANHATTAN KS
66502-3415
US

V. Phone/Fax

Practice location:
  • Phone: 785-587-4300
  • Fax: 785-587-4305
Mailing address:
  • Phone: 785-587-4300
  • Fax: 785-587-4305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1056
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: