Provider Demographics
NPI:1376684068
Name:RIPLEY, DONNA J (PHD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 1ST AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-5108
Mailing Address - Country:US
Mailing Address - Phone:815-626-0201
Mailing Address - Fax:815-626-0254
Practice Address - Street 1:300 1ST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-5108
Practice Address - Country:US
Practice Address - Phone:815-626-0201
Practice Address - Fax:815-626-0254
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003667103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL625960Medicare ID - Type Unspecified