Basic Information
| Provider Information | |||||||||
| NPI: | 1881218253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIPF | ||||||||
| FirstName: | JESSIKAH | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | MS, PPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 W 29TH ST | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820012760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8448957325 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2526 SEYMOUR AVE | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820013159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8448957325 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2020 | ||||||||
| LastUpdateDate: | 02/05/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | PPC-1183 | WY | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.