Provider Demographics
NPI:1669503876
Name:RIPPE, MICHELLE LYNN
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:LYNN
Last Name:RIPPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26747 N 65TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6505
Mailing Address - Country:US
Mailing Address - Phone:623-594-9966
Mailing Address - Fax:
Practice Address - Street 1:14850 N 39TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4510
Practice Address - Country:US
Practice Address - Phone:602-896-5672
Practice Address - Fax:602-896-5620
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL1757235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist