Basic Information
| Provider Information | |||||||||
| NPI: | 1629635313 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RITCHAY | ||||||||
| FirstName: | HALLIE | ||||||||
| MiddleName: | MACKENZIE | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6831 LISA LN | ||||||||
| Address2: | |||||||||
| City: | WISCONSIN RAPIDS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544942311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154595006 | ||||||||
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| Practice Location | |||||||||
| Address1: | GREENFIELD REHABILITATION AGENCY 19395 W CAPITOL DR | ||||||||
| Address2: | STE 200 | ||||||||
| City: | BROOKFIELD | ||||||||
| State: | WI | ||||||||
| PostalCode: | 53045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2629237101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2019 | ||||||||
| LastUpdateDate: | 05/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | WI | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.