Individual
MISS CORISSA RAE KIEPKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5526 N ACADEMY BLVD STE 109, COLORADO SPRINGS, CO 80918-3688
(719) 301-5100
Mailing address
5526 N ACADEMY BLVD STE 109, COLORADO SPRINGS, CO 80918-3688
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-20-123447
CO
Other
Enumeration date
06/15/2020
Last updated
06/15/2020
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