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General NPI Number Information
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NPI Number | 1336702869
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Entity Type | Individual
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Provider Name | JUSTIN ARIK GRIPENTROG CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 04/19/2019
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 6901 SHAWNEE MISSION PKWY
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City | OVERLAND PARK
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State | KS
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Zip | 66202-4005
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Country | US
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Telephone | 888-913-1910
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Fax |
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Provider Business Mailing Address
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Address Line | 93 SUMMIT ST APT 3
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City | PAWTUCKET
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State | RI
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Zip | 02860-4200
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Country | US
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Telephone | 989-327-4789
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP.0003909
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | LL60952352
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP01756
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License Number State | RI
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