1184088387 NPI number — JENNA MARIE TRIPODI-MCILWEE LCMFT

Table of content: JENNA MARIE TRIPODI-MCILWEE LCMFT (NPI 1184088387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184088387 NPI number — JENNA MARIE TRIPODI-MCILWEE LCMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIPODI-MCILWEE
Provider First Name:
JENNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TRIPODI
Provider Other First Name:
JENNA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCMFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184088387
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
322 HOUSTON ST STE 107
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANHATTAN
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66502-6497
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-491-7871
Provider Business Mailing Address Fax Number:
517-258-2951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 POYNTZ AVE STE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANHATTAN
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66502-6332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-491-7871
Provider Business Practice Location Address Fax Number:
517-258-2951
Provider Enumeration Date:
04/13/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  2860 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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