Healthcare Provider Details

I. General information

NPI: 1720940299
Provider Name (Legal Business Name): NICOLE ELIZABETH RIPPEE MC 61510113
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23403 E MISSION AVE STE 151
LIBERTY LAKE WA
99019-7584
US

IV. Provider business mailing address

4412 S CONKLIN RD
GREENACRES WA
99016-9713
US

V. Phone/Fax

Practice location:
  • Phone: 509-655-9843
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61510113
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: