Provider Demographics
NPI:1174643191
Name:RILEY, LISA STERMER (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:STERMER
Last Name:RILEY
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 INDIAN PIPE CT
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7044
Mailing Address - Country:US
Mailing Address - Phone:804-598-2492
Mailing Address - Fax:
Practice Address - Street 1:1627 INDIAN PIPE CT
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7044
Practice Address - Country:US
Practice Address - Phone:804-598-2492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001786235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist