Provider Demographics
NPI:1144867045
Name:KIPP, JENNY
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:KIPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 HARRISON RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6364
Mailing Address - Country:US
Mailing Address - Phone:540-287-4129
Mailing Address - Fax:
Practice Address - Street 1:6230 HARRISON RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6364
Practice Address - Country:US
Practice Address - Phone:540-287-4129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical