Basic Information
| Provider Information | |||||||||
| NPI: | 1881722882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRIPPETT | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MS, LSW, CAC, CCJP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1415 LANCASTER ST | ||||||||
| Address2: | 6B | ||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457509356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044810767 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2121 7TH ST | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261013803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044851721 | ||||||||
| FaxNumber: | 3044856710 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 97-114 | WV | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YA0400X | 06-766 | WV | X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 104100000X | AP00940549 | WV | X | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | AP00940549 | 01 | WV | WV SW LICENSE | OTHER | 97-114 | 01 | WV | CAC | OTHER | 06-766 | 01 | WV | WV CCJP CERTIFICATION | OTHER |