MEDICARE: JOANN RIDGE M.S.-CCC-SLP

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	235Z00000X	Speech-Language Pathologist	SLP1038	AZ

General Provider Information

NPI Number	:	1558412197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANN RIDGE M.S.-CCC-SLP

Provider Business Mailing Address
First Line	:	4692 W OAKLAND ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2924
Country	:	US
Telephone Number	:	480-695-4746
Fax Number	:

Provider Business Practice Location Address
First Line	:	4692 W OAKLAND ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85226-2924
Country	:	US
Telephone Number	:	480-695-4746
Fax Number	:

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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