Provider Demographics
NPI:1366000176
Name:RIPLEY, GREGG
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:RIPLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:IL
Mailing Address - Zip Code:61021-1254
Mailing Address - Country:US
Mailing Address - Phone:814-994-4129
Mailing Address - Fax:815-994-4154
Practice Address - Street 1:922 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:IL
Practice Address - Zip Code:61021-1254
Practice Address - Country:US
Practice Address - Phone:815-994-4129
Practice Address - Fax:815-994-4154
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral