MEDICARE: DEBORAH SUE RIBA L.M.F.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0456	MN

General Provider Information

NPI Number	:	1225140247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH SUE RIBA L.M.F.T.

Provider Business Mailing Address
First Line	:	9001 E BLOOMINGTON FWY
Second Line	:	SUITE 140
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-3435
Country	:	US
Telephone Number	:	952-881-9883
Fax Number	:	952-881-3588

Provider Business Practice Location Address
First Line	:	9001 E BLOOMINGTON FWY
Second Line	:	SUITE 140
City	:	BLOOMINGTON
State	:	MN
Zip	:	55420-3435
Country	:	US
Telephone Number	:	952-881-9883
Fax Number	:	952-881-3588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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