Provider Demographics
NPI:1427618446
Name:HEATHER KIPPEN, LCSW, PLLC
Entity type:Organization
Organization Name:HEATHER KIPPEN, LCSW, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INDIVIDUAL/FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIPPEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:701-839-3909
Mailing Address - Street 1:600 22ND AVE NW STE 1
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-0986
Mailing Address - Country:US
Mailing Address - Phone:701-839-3909
Mailing Address - Fax:701-839-9071
Practice Address - Street 1:600 22ND AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-0986
Practice Address - Country:US
Practice Address - Phone:701-839-3909
Practice Address - Fax:701-839-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1462801Medicaid
ND1477897Medicaid