Provider Demographics
NPI:1508456559
Name:TRIPPLETT, KYNNEDI NIKOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:KYNNEDI
Middle Name:NIKOLE
Last Name:TRIPPLETT
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 1:1005 DES PLAINES AVE APT 208
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-2126
Mailing Address - Country:US
Mailing Address - Phone:205-937-5215
Mailing Address - Fax:
Practice Address - Street 1:5500 S SHORE DR APT 303
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1918
Practice Address - Country:US
Practice Address - Phone:205-937-5215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0247181041C0700X
IL150.103626104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker