Provider Demographics
NPI:1427762343
Name:RAIBLE, NAOMI ELIZABETH
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:ELIZABETH
Last Name:RAIBLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E TERRA LN
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2725
Mailing Address - Country:US
Mailing Address - Phone:636-240-2072
Mailing Address - Fax:
Practice Address - Street 1:150 WATERFORD CROSSING DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7135
Practice Address - Country:US
Practice Address - Phone:636-272-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022047739235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist