Provider Demographics
NPI:1194264663
Name:HIPPENSTEEL, CARL
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:HIPPENSTEEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 RIDGE AVE STE LL15A
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5919
Mailing Address - Country:US
Mailing Address - Phone:312-778-5118
Mailing Address - Fax:
Practice Address - Street 1:1740 RIDGE AVE STE LL15A
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-5919
Practice Address - Country:US
Practice Address - Phone:312-778-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009167101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional