Provider Demographics
NPI:1538370440
Name:LIPPOLD, TIMOTHY A (AUD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:LIPPOLD
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6294
Mailing Address - Country:US
Mailing Address - Phone:715-423-4327
Mailing Address - Fax:715-421-3300
Practice Address - Street 1:2821 8TH ST S
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-6294
Practice Address - Country:US
Practice Address - Phone:715-423-4327
Practice Address - Fax:715-421-3300
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI296-156237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41101700Medicaid
WI41101700Medicaid