MEDICARE: MRS. TANIA LORELL RIFE M.A., 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	174N00000X	Lactation Consultant (Non-RN)
2	235Z00000X	Speech-Language Pathologist	SLP.0001003	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790074946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TANIA LORELL RIFE M.A., CCC/SLP

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

Provider Business Practice Location Address
First Line	:	755 HIGHWAY 105
Second Line	:
City	:	PALMER LAKE
State	:	CO
Zip	:	80133-9039
Country	:	US
Telephone Number	:	719-373-1010
Fax Number	:	719-434-9627

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

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	02/12/2026

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