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General NPI Number Information
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NPI Number | 1093445249
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Entity Type | Individual
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Provider Name | SAMANTHA JEAN TIPPY PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/12/2022
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 210 N HAMMES AVE STE 205
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City | JOLIET
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State | IL
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Zip | 60435-8139
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Country | US
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Telephone | 815-210-5045
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Fax | 815-725-8144
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Provider Business Mailing Address
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Address Line | 38 MESSENGER CT
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City | TOMS RIVER
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State | NJ
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Zip | 08753-6404
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Country | US
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Telephone | 815-210-5045
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Fax | 815-725-8144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071010775
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License Number State | IL
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