Provider Demographics
NPI:1255340055
Name:RIPSCH, JUDY
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:RIPSCH
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 1:325 E TIMBER ST # A
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-2128
Mailing Address - Country:US
Mailing Address - Phone:815-844-2610
Mailing Address - Fax:815-844-2652
Practice Address - Street 1:325 E TIMBER ST # A
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-2128
Practice Address - Country:US
Practice Address - Phone:815-844-2610
Practice Address - Fax:815-844-2652
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490004201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203051Medicare ID - Type Unspecified