=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134260813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAURIE Z LIPPERT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 405 8TH AVE NW SUITE 333
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57401-2762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-225-3622
-----------------------------------------------------
Fax | 605-229-2719
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 405 8TH AVE NW SUITE 333
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57401-2762
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-225-3622
-----------------------------------------------------
Fax | 605-229-2719
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. LAURIE Z LIPPERT
-----------------------------------------------------
Credential | MSW LCSW
-----------------------------------------------------
Telephone | 605-225-3622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 2084
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------