Provider Demographics
NPI:1215203096
Name:KRIEG, EILEEN MARIE (SLP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:MARIE
Last Name:KRIEG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:EILEEN
Other - Middle Name:MARIE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:134 E STATE ST
Mailing Address - Street 2:#1
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3431
Mailing Address - Country:US
Mailing Address - Phone:217-390-6128
Mailing Address - Fax:
Practice Address - Street 1:489 DEVON PARK DRIVE
Practice Address - Street 2:#301
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087
Practice Address - Country:US
Practice Address - Phone:484-367-7131
Practice Address - Fax:215-879-8424
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL010779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist