Provider Demographics
NPI:1033120563
Name:RILEY, NICOLE SCHNEIDER (SLP)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:SCHNEIDER
Last Name:RILEY
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 1:12025 SAN JOSE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-1639
Mailing Address - Country:US
Mailing Address - Phone:904-880-1444
Mailing Address - Fax:850-325-6302
Practice Address - Street 1:12025 SAN JOSE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-1639
Practice Address - Country:US
Practice Address - Phone:904-880-1444
Practice Address - Fax:904-517-1621
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8779235Z00000X
FLSA8779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891077400Medicaid
GA116666937AMedicaid