Healthcare Provider Details

I. General information

NPI: 1013652676
Provider Name (Legal Business Name): ROSALIE RIPLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 HIGHLAND DR
PARK CITY UT
84098-6139
US

IV. Provider business mailing address

3510 S 2300 E
SALT LAKE CITY UT
84109-3464
US

V. Phone/Fax

Practice location:
  • Phone: 435-334-5576
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11912811-6009
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: