Provider Demographics
NPI:1053459826
Name:RIDDELL, MANDEE L (AUD)
Entity Type:Individual
Prefix:MRS
First Name:MANDEE
Middle Name:L
Last Name:RIDDELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 N GRAND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-4107
Mailing Address - Country:US
Mailing Address - Phone:859-572-4103
Mailing Address - Fax:859-572-3044
Practice Address - Street 1:7575 US HIGHWAY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1939
Practice Address - Country:US
Practice Address - Phone:859-283-6044
Practice Address - Fax:859-283-6046
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0469231H00000X, 235Z00000X
KY0941237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0469OtherSPEECH-LANG. PATH AND AUD
KY0941OtherLIC. FOR HEARING INST.
IN23002402AOtherAUDIOLOGIST LICENSE