Provider Demographics
NPI:1427663335
Name:WIPPEL, CANDICE JOLEEN
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:JOLEEN
Last Name:WIPPEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:WILBUR
Mailing Address - State:WA
Mailing Address - Zip Code:99185-0216
Mailing Address - Country:US
Mailing Address - Phone:509-641-0192
Mailing Address - Fax:
Practice Address - Street 1:109 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILBUR
Practice Address - State:WA
Practice Address - Zip Code:99185
Practice Address - Country:US
Practice Address - Phone:509-647-5500
Practice Address - Fax:509-647-0128
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60948177225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist