MEDICARE: KATHLEEN M TRIPP

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	237700000X	Hearing Instrument Specialist	HAD6129	AZ

General Provider Information

NPI Number	:	1821309527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN M TRIPP

Provider Business Mailing Address
First Line	:	6124 E BROWN RD
Second Line	:	STE 102
City	:	MESA
State	:	AZ
Zip	:	85205-4959
Country	:	US
Telephone Number	:	480-497-3285
Fax Number	:	480-833-2513

Provider Business Practice Location Address
First Line	:	6124 E BROWN RD
Second Line	:	STE 102
City	:	MESA
State	:	AZ
Zip	:	85205-4959
Country	:	US
Telephone Number	:	480-497-3285
Fax Number	:	480-833-2513

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

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	06/28/2010

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Directions to “ KATHLEEN M TRIPP ” Practice Location

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