Healthcare Provider Details

I. General information

NPI: 1043173198
Provider Name (Legal Business Name): ISABELLE CLAIRE RIDGEWAY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 W WORLEY ST
COLUMBIA MO
65203-1038
US

IV. Provider business mailing address

104 E STEWART RD APT 20
COLUMBIA MO
65203-4279
US

V. Phone/Fax

Practice location:
  • Phone: 573-214-3400
  • Fax:
Mailing address:
  • Phone: 469-534-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: