Provider Demographics
NPI:1841646882
Name:STYPA, NIKKI (PSYD)
Entity type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:
Last Name:STYPA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NIKKI
Other - Middle Name:J
Other - Last Name:STYPA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1240 SE BISHOP BLVD STE Q
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5439
Mailing Address - Country:US
Mailing Address - Phone:509-334-0782
Mailing Address - Fax:
Practice Address - Street 1:1240 SE BISHOP BLVD
Practice Address - Street 2:STE Q
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5439
Practice Address - Country:US
Practice Address - Phone:509-334-0782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60481617103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841646882OtherNPI