| Lipp, Carlson, Witucki & Associates, Ltd | |
|
2808 17th Ave S Grand Forks ND 58201-4010 | |
| (701) 746-8376 | |
| (701) 746-9872 |
| Full Name | Lipp, Carlson, Witucki & Associates, Ltd |
|---|---|
| Speciality | Psychologist |
| Location | 2808 17th Ave S, Grand Forks, North Dakota |
| Authorized Official Name and Position | Priscilla Marto (OFFICE MANAGER) |
| Authorized Official Contact | 7017468376 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lipp, Carlson, Witucki & Associates, Ltd 2808 17th Ave S Grand Forks ND 58201-4010 Ph: (701) 746-8376 | Lipp, Carlson, Witucki & Associates, Ltd 2808 17th Ave S Grand Forks ND 58201-4010 Ph: (701) 746-8376 |
| NPI Number | 1043316961 |
|---|---|
| Provider Enumeration Date | 09/16/2006 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 2062408701 |
|---|---|
| Medicare Enrollment ID | O20040420001654 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043316961 | NPI | - | NPPES |
| 007089100 | Medicaid | MN | |
| 10098 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (North Dakota) | Primary |
| Provider Name | Jonathan E Whalen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1043240914 PECOS PAC ID: 7113959990 Enrollment ID: I20050831000861 |
| Provider Name | Katherine Dusenbury |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720150642 PECOS PAC ID: 1557464625 Enrollment ID: I20070309000281 |
| Provider Name | Holly J Wolf |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598095697 PECOS PAC ID: 5294850368 Enrollment ID: I20100913000741 |
| Provider Name | Brenda J King |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598799892 PECOS PAC ID: 7517990062 Enrollment ID: I20101101001443 |
| Provider Name | Tara L Shirek |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407067994 PECOS PAC ID: 8123346418 Enrollment ID: I20150416002234 |
| Provider Name | Kylee J Roller |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1750415873 PECOS PAC ID: 3779888292 Enrollment ID: I20160222001488 |
| Provider Name | Amanda M Blake |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1174773469 PECOS PAC ID: 7810262243 Enrollment ID: I20171010002901 |
| Provider Name | Susan A Spivey |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447310339 PECOS PAC ID: 6406112846 Enrollment ID: I20171117001219 |
| Provider Name | John Campbell |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407344328 PECOS PAC ID: 0244574424 Enrollment ID: I20181128001898 |
| Provider Name | Sheryl Holter Vogel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1811516586 PECOS PAC ID: 3072944180 Enrollment ID: I20200506003360 |
| Provider Name | Talia K Telander |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760720395 PECOS PAC ID: 3072958982 Enrollment ID: I20240301002257 |
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