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General NPI Number Information
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NPI Number | 1649925082
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Entity Type | Individual
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Provider Name | STEPHANNEY TIPSORD LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/15/2022
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 3501 BERRYWOOD DR
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City | COLUMBIA
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State | MO
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Zip | 65201-6584
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Country | US
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Telephone | 844-853-8937
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Fax |
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Provider Business Mailing Address
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Address Line | 325 IL ROUTE 2
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City | DIXON
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State | IL
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Zip | 61021-9118
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Country | US
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Telephone | 815-284-6611
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2025033786
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License Number State | MO
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