Provider Demographics
NPI:1881218253
Name:KIPF, JESSIKAH LEE (MS, PPC)
Entity Type:Individual
Prefix:
First Name:JESSIKAH
Middle Name:LEE
Last Name:KIPF
Suffix:
Gender:F
Credentials:MS, PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2760
Mailing Address - Country:US
Mailing Address - Phone:844-895-7325
Mailing Address - Fax:
Practice Address - Street 1:2526 SEYMOUR AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3159
Practice Address - Country:US
Practice Address - Phone:844-895-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-02
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1183101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor