Provider Information for 1568683662
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KELLY PHIPPS GESKER LCPC, ADTR, NCC
Sex: Female
NPI: 1568683662
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1568683662 | ||||||||
| Enumeration Date | 2007-05-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2209 WIDGEON CT. KALISPELL, MT 59901 United States Phone: 406-257-1854 | Fax: | ||||||||
| Primary Practice Address | 28 W. CALIFORNIA ST. KALISPELL, MT 59901 United States Phone: 406-249-5553 | Fax: | ||||||||
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