Provider Demographics
NPI:1114350303
Name:VENABLE, RISA L (SLP)
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:L
Last Name:VENABLE
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 1:736 MAIN ST
Mailing Address - Street 2:SPECIAL SERVICES
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1656
Mailing Address - Country:US
Mailing Address - Phone:660-882-7474
Mailing Address - Fax:660-882-5721
Practice Address - Street 1:736 MAIN ST
Practice Address - Street 2:SPECIAL SERVICES
Practice Address - City:BOONVILLE
Practice Address - State:MO
Practice Address - Zip Code:65233-1656
Practice Address - Country:US
Practice Address - Phone:660-882-7474
Practice Address - Fax:660-882-5721
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009004346235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist