MEDICARE: DR. SHARON ANDERSON RIPPNER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY6297	CA

General Provider Information

NPI Number	:	1386978047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON ANDERSON RIPPNER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 246
Second Line	:
City	:	AVILA BEACH
State	:	CA
Zip	:	93424-0246
Country	:	US
Telephone Number	:	805-748-2844
Fax Number	:	805-595-9629

Provider Business Practice Location Address
First Line	:	1521 HIGUERA ST
Second Line	:	SUITE E
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2958
Country	:	US
Telephone Number	:	805-748-2844
Fax Number	:	805-595-9629

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	09/29/2009

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