Provider Demographics
NPI:1780090795
Name:RIPLEY, BETHANN WEISS (SLP)
Entity type:Individual
Prefix:MRS
First Name:BETHANN
Middle Name:WEISS
Last Name:RIPLEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:ANN
Other - Last Name:WEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:303 N HURSTBOURNE PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-5185
Mailing Address - Country:US
Mailing Address - Phone:502-412-5847
Mailing Address - Fax:
Practice Address - Street 1:3500 COOLIDGE RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-6376
Practice Address - Country:US
Practice Address - Phone:517-203-4042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101003884235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist