Provider Demographics
NPI:1386959443
Name:RICE, MARY ELIZABETH RYBAK (AUD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH RYBAK
Last Name:RICE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:RYBAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 TOWER GROVE AVE
Mailing Address - Street 2:APT. 2 SOUTH
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3573
Mailing Address - Country:US
Mailing Address - Phone:314-498-1483
Mailing Address - Fax:
Practice Address - Street 1:4790 EXECUTIVE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1606
Practice Address - Country:US
Practice Address - Phone:636-441-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020778231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist