Provider Demographics
NPI:1609691534
Name:LIPP, LUZ Y
Entity type:Individual
Prefix:
First Name:LUZ
Middle Name:Y
Last Name:LIPP
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 1:115 SUMMIT AVE N APT 3
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4772
Mailing Address - Country:US
Mailing Address - Phone:509-952-5268
Mailing Address - Fax:
Practice Address - Street 1:115 SUMMIT AVE N APT 3
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030-4772
Practice Address - Country:US
Practice Address - Phone:509-952-5268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician