Provider Demographics
NPI:1649798497
Name:BERRY-TIPPETT, KELSEY (PSYD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BERRY-TIPPETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:9301 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7745
Mailing Address - Country:US
Mailing Address - Phone:312-569-8387
Mailing Address - Fax:
Practice Address - Street 1:9301 MADISON ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7745
Practice Address - Country:US
Practice Address - Phone:312-569-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.010620103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist