Basic Information
| Provider Information | |||||||||
| NPI: | 1912412339 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIPPLE LANGUAGE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11125 PARK BLVD STE 104-182 | ||||||||
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| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337724757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074321597 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1929 HAMMERLIN AVE | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327896609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074321597 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2017 | ||||||||
| LastUpdateDate: | 12/07/2017 | ||||||||
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| AuthorizedOfficialLastName: | LONGO | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SPEECH-LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 4074321597 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.S. CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA6858 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.