Provider Demographics
NPI:1336702869
Name:GRIPENTROG, JUSTIN ARIK (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ARIK
Last Name:GRIPENTROG
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 SUMMIT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4200
Mailing Address - Country:US
Mailing Address - Phone:989-327-4789
Mailing Address - Fax:
Practice Address - Street 1:6901 SHAWNEE MISSION PKWY
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4005
Practice Address - Country:US
Practice Address - Phone:888-913-1910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-19
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003909235Z00000X
WALL60952352235Z00000X
RISP01756235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist