Provider Demographics
NPI:1689144842
Name:SIPPIO, KIERSTEN VICTORIA
Entity Type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:VICTORIA
Last Name:SIPPIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 RUSINA RD STE A
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8127
Mailing Address - Country:US
Mailing Address - Phone:504-234-9433
Mailing Address - Fax:
Practice Address - Street 1:4820 RUSINA RD STE A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8127
Practice Address - Country:US
Practice Address - Phone:504-234-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38984103G00000X, 103TC0700X
COPSY.0005776103G00000X, 103TC0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician