Provider Demographics
NPI:1447140595
Name:LIPSCOMB, LEILANI AALIYAH
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:AALIYAH
Last Name:LIPSCOMB
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 1:1616 MARTY CT
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0514
Mailing Address - Country:US
Mailing Address - Phone:209-404-5798
Mailing Address - Fax:
Practice Address - Street 1:2313 E WHITMORE AVE
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2611
Practice Address - Country:US
Practice Address - Phone:408-439-6308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician