Provider Demographics
NPI:1417467663
Name:RITTER, RACHEL ANTRIM (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANTRIM
Last Name:RITTER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:KATHRYN
Other - Last Name:ANTRIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:1000 E UNIVERSITY AVE # 3311
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82071-2001
Mailing Address - Country:US
Mailing Address - Phone:307-766-6424
Mailing Address - Fax:
Practice Address - Street 1:1000 E UNIVERSITY AVE # 3311
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82071-2001
Practice Address - Country:US
Practice Address - Phone:307-766-6424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK125430235Z00000X
WYSP-1227235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist