Healthcare Provider Details

I. General information

NPI: 1497202683
Provider Name (Legal Business Name): JENNIFER SIPES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 5TH AVE
CHAMBERSBURG PA
17201-4219
US

IV. Provider business mailing address

755 NORLAND AVE 200
CHAMBERSBURG PA
17201-4221
US

V. Phone/Fax

Practice location:
  • Phone: 717-709-7930
  • Fax: 717-709-7931
Mailing address:
  • Phone: 717-709-7922
  • Fax: 717-263-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number0904006138
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW-019271
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: