Provider Demographics
NPI:1477096428
Name:RIEBEL, MANDA FLORENCE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MANDA
Middle Name:FLORENCE
Last Name:RIEBEL
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 LANNON COURT NE
Mailing Address - Street 2:
Mailing Address - City:SAINT MICHAEL
Mailing Address - State:MN
Mailing Address - Zip Code:55376
Mailing Address - Country:US
Mailing Address - Phone:763-913-4624
Mailing Address - Fax:
Practice Address - Street 1:11091 JASON AVE NE STE 2
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55301-4703
Practice Address - Country:US
Practice Address - Phone:763-744-4164
Practice Address - Fax:763-497-0679
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6308235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist