Provider Demographics
NPI:1851676498
Name:RIPPENTROP, PETER JASON (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JASON
Last Name:RIPPENTROP
Suffix:
Gender:M
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:
Other - Last Name:RIPPENTROP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:602 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2102
Mailing Address - Country:US
Mailing Address - Phone:952-361-1600
Mailing Address - Fax:952-361-1660
Practice Address - Street 1:309 LAKE HAZELTINE DR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1033
Practice Address - Country:US
Practice Address - Phone:952-567-8259
Practice Address - Fax:952-368-8888
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00355101YP2500X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional