Provider Demographics
NPI:1306144597
Name:WIPSON, EDWARD C (MS LPC CSAC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:C
Last Name:WIPSON
Suffix:
Gender:M
Credentials:MS LPC CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 TOWER AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2532
Mailing Address - Country:US
Mailing Address - Phone:715-392-3331
Mailing Address - Fax:
Practice Address - Street 1:1507 TOWER AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2532
Practice Address - Country:US
Practice Address - Phone:715-392-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2025-132101YA0400X
WI2342-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)