Provider Demographics
NPI:1346964350
Name:JIPP, KELSEY NICKOLE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:NICKOLE
Last Name:JIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KELSEY
Other - Middle Name:NICKOLE
Other - Last Name:KREHOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1065 18TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-1313
Mailing Address - Country:US
Mailing Address - Phone:503-999-7244
Mailing Address - Fax:
Practice Address - Street 1:3876 BEVERLY AVE NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1319
Practice Address - Country:US
Practice Address - Phone:503-576-4536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist