Provider Demographics
NPI:1366951667
Name:SIPPL, AMY L (BCBA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SIPPL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:DUCHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2419 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-2619
Mailing Address - Country:US
Mailing Address - Phone:715-610-6396
Mailing Address - Fax:
Practice Address - Street 1:2419 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-2619
Practice Address - Country:US
Practice Address - Phone:715-610-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1-17-27512103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst