Provider Demographics
NPI:1427126564
Name:RAIBLEY, ANN B (CCC-A)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:B
Last Name:RAIBLEY
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-426-9371
Mailing Address - Fax:812-426-6610
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9371
Practice Address - Fax:812-426-6610
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23000939A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000252028OtherANTHEM
IN100097520Medicaid
IN000000252028OtherANTHEM
IN700004828Medicare PIN
IN100097520Medicaid