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NPI Code Detail

MEDICARE: KIMBERLY ALEXIS LIPPOLDT BCBA

MEDICARE: KIMBERLY ALEXIS LIPPOLDT BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianRBT-19-103790OK
2103K00000XBehavior Analyst1-21-51557OK

General Provider Information

NPI Number : 1700420874
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY ALEXIS LIPPOLDT BCBA
Provider Business Mailing Address
First Line : 13301 SW 2ND TER
Second Line :
City : YUKON
State : OK
Zip : 73099-7173
Country : US
Telephone Number : 405-664-1288
Fax Number :
Provider Business Practice Location Address
First Line : 13905 TECHNOLOGY DR STE A1
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73134-1054
Country : US
Telephone Number : 405-455-6868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2019
Last Update Date : 05/02/2023

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