Active NPI
Marion Isabel Adelheid Zipperle, PHD
- Clinical Psychologist
- Santa Rosa, CA
National Provider Identifier
1073673836
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY12203
- Practice address
- 100 E St Ste 306
Santa Rosa, CA 95404-4607 - Phone
- (707) 527-9960
- Fax
- (707) 823-1342
- NPI assigned
- Dec 11, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY12203 | CA | Primary |
Addresses
Primary practice location
100 E St Ste 306
Santa Rosa, CA 95404-4607
Mailing address
2530 Sanders Road
Sebastopol, CA 95472
Phone (707) 527-9960
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| OPL122030 | Other | CA | PTAN |
| PSY122030 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12203 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354492800000",
"number": "1073673836",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2530 SANDERS ROAD",
"city": "SEBASTOPOL",
"state": "CA",
"postal_code": "95472",
"telephone_number": "707-527-9960",
"fax_number": "707-823-1342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 E ST STE 306",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954044607",
"telephone_number": "707-527-9960",
"fax_number": "707-823-1342"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZIPPERLE",
"first_name": "MARION ISABEL",
"middle_name": "ADELHEID",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-11",
"last_updated": "2012-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY12203",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "OPL122030",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY122030",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.