Healthcare Provider Details

I. General information

NPI: 1972747723
Provider Name (Legal Business Name): MELISSA A IPSEN MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 STINSON AVE
CHEYENNE WY
82001-3319
US

IV. Provider business mailing address

1504 STINSON AVE
CHEYENNE WY
82001-3319
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-8064
  • Fax: 307-632-6131
Mailing address:
  • Phone: 307-632-8064
  • Fax: 307-632-6131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number297
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: