1790074946 NPI number — MRS. TANIA LORELL RIFE M.A., CCC/SLP

Table of content: MRS. TANIA LORELL RIFE M.A., CCC/SLP (NPI 1790074946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790074946 NPI number — MRS. TANIA LORELL RIFE M.A., CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIFE
Provider First Name:
TANIA
Provider Middle Name:
LORELL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC/SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790074946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 430
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALMER LAKE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80133-0430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-373-1010
Provider Business Mailing Address Fax Number:
719-434-9627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755 HIGHWAY 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALMER LAKE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80133-9039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-373-1010
Provider Business Practice Location Address Fax Number:
719-434-9627
Provider Enumeration Date:
03/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SLP.0001003 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 73934283 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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