Provider Demographics
NPI:1093445249
Name:TIPPY, SAMANTHA JEAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:JEAN
Last Name:TIPPY
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MESSENGER CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-6404
Mailing Address - Country:US
Mailing Address - Phone:815-210-5045
Mailing Address - Fax:815-725-8144
Practice Address - Street 1:210 N HAMMES AVE STE 205
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8139
Practice Address - Country:US
Practice Address - Phone:815-210-5045
Practice Address - Fax:815-725-8144
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071010775103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical