Provider Demographics
NPI:1265122360
Name:TIPPEN, ANDREW PATRICK (SLP)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:PATRICK
Last Name:TIPPEN
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8211 FOX HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GOODRICH
Mailing Address - State:MI
Mailing Address - Zip Code:48438-9237
Mailing Address - Country:US
Mailing Address - Phone:810-288-9437
Mailing Address - Fax:
Practice Address - Street 1:935 UNION LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-4529
Practice Address - Country:US
Practice Address - Phone:248-360-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7152000576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist