Provider Demographics
NPI:1114097201
Name:RIPP, PATRICIA MARIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIE
Last Name:RIPP
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:MARIE
Other - Last Name:NOBLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1898 JAHNS DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-8479
Mailing Address - Country:US
Mailing Address - Phone:847-205-6577
Mailing Address - Fax:
Practice Address - Street 1:919 N PLUM GROVE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5144
Practice Address - Country:US
Practice Address - Phone:847-205-6577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632048Medicare UPIN