Provider Demographics
NPI:1437438751
Name:DOCKENDORFF, TRISHA DEE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:DEE
Last Name:DOCKENDORFF
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:DEE
Other - Last Name:RIESKAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:6744 KELSEYS OAK CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-1093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8650 GOVERNORS HILL DR
Practice Address - Street 2:#180
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-1372
Practice Address - Country:US
Practice Address - Phone:513-791-5766
Practice Address - Fax:435-645-0792
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.8686235Z00000X
KYKY-3546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist