Healthcare Provider Details

I. General information

NPI: 1790493658
Provider Name (Legal Business Name): ANTHONY M ZIPPLE SC.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 ROUND RIDGE RD
LOUISVILLE KY
40207-1607
US

IV. Provider business mailing address

1801 ROUND RIDGE RD
LOUISVILLE KY
40207-1607
US

V. Phone/Fax

Practice location:
  • Phone: 502-442-6371
  • Fax:
Mailing address:
  • Phone: 502-442-6371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number4628
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: