MEDICARE: RACHEL ANTRIM RITTER M.S. CCC-SLP

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	235Z00000X	Speech-Language Pathologist	125430	AK
2	235Z00000X	Speech-Language Pathologist	SP-1227	WY

General Provider Information

NPI Number	:	1417467663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ANTRIM RITTER M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1000 E UNIVERSITY AVE # 3311
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82071-2001
Country	:	US
Telephone Number	:	307-766-6424
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 E UNIVERSITY AVE # 3311
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82071-2001
Country	:	US
Telephone Number	:	307-766-6424
Fax Number	:

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

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	08/23/2021

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Directions to “ RACHEL ANTRIM RITTER M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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