Provider Demographics
NPI:1912274069
Name:SHIPMAN, JESSICA KAY (ACADC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KAY
Last Name:SHIPMAN
Suffix:
Gender:F
Credentials:ACADC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:KAY
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 TETON DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9725
Mailing Address - Country:US
Mailing Address - Phone:319-352-1353
Mailing Address - Fax:319-352-2329
Practice Address - Street 1:111 10TH ST SW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2925
Practice Address - Country:US
Practice Address - Phone:319-352-1353
Practice Address - Fax:319-352-2329
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)