Provider Demographics
NPI:1730526047
Name:RIDGENAL, SHARRON A
Entity type:Individual
Prefix:MS
First Name:SHARRON
Middle Name:A
Last Name:RIDGENAL
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 1:18103 S. 66TH COURT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4106
Mailing Address - Country:US
Mailing Address - Phone:708-429-7336
Mailing Address - Fax:
Practice Address - Street 1:18103 66TH CT
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4106
Practice Address - Country:US
Practice Address - Phone:708-429-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL217.0000622355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant