Healthcare Provider Details

I. General information

NPI: 1922632165
Provider Name (Legal Business Name): AMY SUE TIPPIN BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2020
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4761 TUTTLE CREEK BLVD
MANHATTAN KS
66502-9079
US

IV. Provider business mailing address

4761 TUTTLE CREEK BLVD
MANHATTAN KS
66502-9079
US

V. Phone/Fax

Practice location:
  • Phone: 785-587-1825
  • Fax:
Mailing address:
  • Phone: 785-587-1825
  • Fax: 785-596-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0-26-16851
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: