=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871486118
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA M ZIPSER MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2025
-----------------------------------------------------
Last Update Date | 06/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2240 WEST SOUTH AIRPORT ROAD
-----------------------------------------------------
City | TRAVERSE CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-590-3732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6255 US HIGHWAY 31 N APT 204
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49690-9467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 231-360-0356
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 6851111258
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------