Provider Demographics
NPI:1013381698
Name:RIES, KAMALA (SLP)
Entity Type:Individual
Prefix:
First Name:KAMALA
Middle Name:
Last Name:RIES
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 IVYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-2567
Mailing Address - Country:US
Mailing Address - Phone:719-565-1276
Mailing Address - Fax:719-565-2313
Practice Address - Street 1:3960 IVYWOOD LN
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-2567
Practice Address - Country:US
Practice Address - Phone:719-565-1276
Practice Address - Fax:719-565-2313
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00000019235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist