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General NPI Number Information
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NPI Number | 1477096428
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Entity Type | Individual
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Provider Name | MANDA FLORENCE RIEBEL MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 11091 JASON AVE NE STE 2
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City | ALBERTVILLE
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State | MN
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Zip | 55301-4703
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Country | US
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Telephone | 763-744-4164
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Fax | 763-497-0679
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Provider Business Mailing Address
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Address Line | 4690 LANNON COURT NE
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City | SAINT MICHAEL
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State | MN
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Zip | 55376
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Country | US
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Telephone | 763-913-4624
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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 | 6308
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License Number State | MN
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