Provider Demographics
NPI:1669876538
Name:GRIPKA, ABBEY ALYSSA CAMPBELL (PHD)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:ALYSSA CAMPBELL
Last Name:GRIPKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W 19TH TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2026
Mailing Address - Country:US
Mailing Address - Phone:816-404-5986
Mailing Address - Fax:816-404-5739
Practice Address - Street 1:300 W 19TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2026
Practice Address - Country:US
Practice Address - Phone:816-404-5986
Practice Address - Fax:816-404-5739
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014037341103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490018153Medicaid