Provider Demographics
NPI:1174338859
Name:LIPKA, JADE
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:LIPKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 E FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:MT
Mailing Address - Zip Code:59041-9730
Mailing Address - Country:US
Mailing Address - Phone:406-425-0526
Mailing Address - Fax:
Practice Address - Street 1:224 E FRONT AVE
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:MT
Practice Address - Zip Code:59041-9730
Practice Address - Country:US
Practice Address - Phone:406-425-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program