Provider Demographics
NPI:1548670276
Name:PIPKIN, SHANDRA KAYE (MED, BCBA)
Entity type:Individual
Prefix:
First Name:SHANDRA
Middle Name:KAYE
Last Name:PIPKIN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7456 S 1740 E
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEBER
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6636
Mailing Address - Country:US
Mailing Address - Phone:801-923-8773
Mailing Address - Fax:844-965-9282
Practice Address - Street 1:7456 S 1740 E
Practice Address - Street 2:
Practice Address - City:SOUTH WEBER
Practice Address - State:UT
Practice Address - Zip Code:84405-6636
Practice Address - Country:US
Practice Address - Phone:801-923-8773
Practice Address - Fax:844-965-9282
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0-09-3699103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst