Provider Demographics
NPI:1760082200
Name:RIPPY, STACEY D (SLP-A)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:D
Last Name:RIPPY
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S DIVISION ST STE A
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-3800
Mailing Address - Country:US
Mailing Address - Phone:509-764-6644
Mailing Address - Fax:509-764-6676
Practice Address - Street 1:618 S ALDER ST
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1760
Practice Address - Country:US
Practice Address - Phone:509-764-6644
Practice Address - Fax:509-764-6676
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician