Provider Demographics
NPI:1912208406
Name:SIPES, KENNETH MOSES JR
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:MOSES
Last Name:SIPES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1310
Mailing Address - Country:US
Mailing Address - Phone:916-448-7391
Mailing Address - Fax:
Practice Address - Street 1:2230 9TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1310
Practice Address - Country:US
Practice Address - Phone:916-448-7391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health