Healthcare Provider Details

I. General information

NPI: 1225884943
Provider Name (Legal Business Name): SOPHIA WHIPPLE TLLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 07/22/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S CARMEL ST
CADILLAC MI
49601-2344
US

IV. Provider business mailing address

805 S CARMEL ST
CADILLAC MI
49601-2344
US

V. Phone/Fax

Practice location:
  • Phone: 231-775-6517
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6352000980
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: