MEDICARE: MS. DANIELLE JACKSON LIPPOLDT M.A.

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
1	235Z00000X	Speech-Language Pathologist	2202005994	VA
2	103K00000X	Behavior Analyst	0133000608	VA

General Provider Information

NPI Number	:	1720391022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANIELLE JACKSON LIPPOLDT M.A.

Provider Business Mailing Address
First Line	:	373 EDWIN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4522
Country	:	US
Telephone Number	:	757-301-2411
Fax Number	:	888-966-0621

Provider Business Practice Location Address
First Line	:	373 EDWIN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4522
Country	:	US
Telephone Number	:	757-803-5663
Fax Number	:	757-938-6944

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2010
Last Update Date	:	09/11/2025

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Directions to “ MS. DANIELLE JACKSON LIPPOLDT M.A.” Practice Location

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