Provider Demographics
NPI:1477194595
Name:TRIPP, JESSICA SHANNON (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:SHANNON
Last Name:TRIPP
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:JESS
Other - Middle Name:SHANNON
Other - Last Name:RITCHHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6549 TOWN CENTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-4824
Mailing Address - Country:US
Mailing Address - Phone:248-620-6400
Mailing Address - Fax:
Practice Address - Street 1:26522 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:CENTER LINE
Practice Address - State:MI
Practice Address - Zip Code:48015-1221
Practice Address - Country:US
Practice Address - Phone:586-759-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010868581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical