Provider Demographics
NPI:1538479209
Name:RIPLEY, KIM (LCSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:RIPLEY
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 1:1949 SUGARLAND DR STE 218
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5765
Mailing Address - Country:US
Mailing Address - Phone:307-674-8686
Mailing Address - Fax:307-674-1825
Practice Address - Street 1:1949 SUGARLAND DR STE 218
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-5765
Practice Address - Country:US
Practice Address - Phone:307-674-8686
Practice Address - Fax:307-674-1825
Is Sole Proprietor?:No
Enumeration Date:2010-10-15
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WYLCSW-8451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical