Provider Demographics
NPI:1417076746
Name:RIPP, KATHRYN ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:RIPP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 ATWOOD AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5744
Mailing Address - Country:US
Mailing Address - Phone:608-630-9444
Mailing Address - Fax:
Practice Address - Street 1:2713 ATWOOD AVE APT 201
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5744
Practice Address - Country:US
Practice Address - Phone:608-630-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1402-132101YA0400X
WI2554-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39231200Medicaid