Provider Demographics
NPI:1336230002
Name:FRESQUEZ-RIPLEY, GINA DANIELLE (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:DANIELLE
Last Name:FRESQUEZ-RIPLEY
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 LUELLA ANNE DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3911
Mailing Address - Country:US
Mailing Address - Phone:505-720-9547
Mailing Address - Fax:505-828-9531
Practice Address - Street 1:7201 LUELLA ANNE DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3911
Practice Address - Country:US
Practice Address - Phone:505-720-9547
Practice Address - Fax:505-828-9531
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1135235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist