Healthcare Provider Details

I. General information

NPI: 1336274174
Provider Name (Legal Business Name): TAMI LOREE DIPZINSKI MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 N BARLOW RD
HARRISVILLE MI
48740-9607
US

IV. Provider business mailing address

PO BOX 279
LINCOLN MI
48742-0279
US

V. Phone/Fax

Practice location:
  • Phone: 989-736-8157
  • Fax:
Mailing address:
  • Phone: 989-736-8157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6803073746
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: