Provider Demographics
NPI:1821309527
Name:TRIPP, KATHLEEN M
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:TRIPP
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 1:6124 E BROWN RD
Mailing Address - Street 2:STE 102
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4959
Mailing Address - Country:US
Mailing Address - Phone:480-497-3285
Mailing Address - Fax:480-833-2513
Practice Address - Street 1:6124 E BROWN RD
Practice Address - Street 2:STE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4959
Practice Address - Country:US
Practice Address - Phone:480-497-3285
Practice Address - Fax:480-833-2513
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD6129237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist