Healthcare Provider Details

I. General information

NPI: 1588964415
Provider Name (Legal Business Name): MICHELLE ELIZABETH RIDENOUR AU.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 S MAIN ST STE B
GOSHEN IN
46526-5200
US

IV. Provider business mailing address

2012 S MAIN ST STE B
GOSHEN IN
46526-5200
US

V. Phone/Fax

Practice location:
  • Phone: 574-534-2025
  • Fax: 574-534-2042
Mailing address:
  • Phone: 574-534-2025
  • Fax: 574-534-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberL1853937
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: