Provider Demographics
NPI:1700225067
Name:RICKENBACH, BRYNA LEE (CCC-A)
Entity Type:Individual
Prefix:
First Name:BRYNA
Middle Name:LEE
Last Name:RICKENBACH
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:BRYNA
Other - Middle Name:LEE
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:SUITE 1K
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1705 WARREN AVE
Practice Address - Street 2:SUITE 204-205
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-2647
Practice Address - Country:US
Practice Address - Phone:570-320-7474
Practice Address - Fax:570-320-7479
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001520231H00000X
PAAT006327231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter