Healthcare Provider Details

I. General information

NPI: 1861324303
Provider Name (Legal Business Name): IRENE VAN RIPER ED.D.
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 KNAPP RD
CLARKS SUMMIT PA
18411-2048
US

IV. Provider business mailing address

500 KNAPP RD
CLARKS SUMMIT PA
18411-2048
US

V. Phone/Fax

Practice location:
  • Phone: 704-577-6616
  • Fax:
Mailing address:
  • Phone: 704-577-6616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPCO14797
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: