Provider Demographics
NPI:1790074946
Name:RIFE, TANIA LORELL (MA, CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:LORELL
Last Name:RIFE
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:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:PALMER LAKE
Mailing Address - State:CO
Mailing Address - Zip Code:80133-0430
Mailing Address - Country:US
Mailing Address - Phone:719-373-1010
Mailing Address - Fax:719-434-9627
Practice Address - Street 1:755 HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133-9039
Practice Address - Country:US
Practice Address - Phone:719-373-1010
Practice Address - Fax:719-434-9627
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174N00000X
COSLP.0001003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73934283Medicaid