Provider Demographics
NPI:1376980623
Name:TRIPLETT, JESSICA M (MA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MILLER ST.
Mailing Address - Street 2:RIVER PLACE COUNSELING & WELLNESS
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-1944
Mailing Address - Country:US
Mailing Address - Phone:208-750-1802
Mailing Address - Fax:208-750-1803
Practice Address - Street 1:312 MILLER ST.
Practice Address - Street 2:RIVER PLACE COUNSELING & WELLNESS
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1944
Practice Address - Country:US
Practice Address - Phone:208-750-1802
Practice Address - Fax:208-750-1803
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1000001OtherWA STATE LICENSE