Provider Demographics
NPI:1386332575
Name:TIPPETT, MADELINE KAREN (MA, ATR, LPC)
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:KAREN
Last Name:TIPPETT
Suffix:
Gender:F
Credentials:MA, ATR, LPC
Other - Prefix:MS
Other - First Name:MADELINE
Other - Middle Name:KAREN
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, ATR, LPC
Mailing Address - Street 1:4211 N PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61616-7754
Mailing Address - Country:US
Mailing Address - Phone:309-691-5502
Mailing Address - Fax:
Practice Address - Street 1:4211 N PROSPECT RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61616-7754
Practice Address - Country:US
Practice Address - Phone:309-691-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.016362101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional