Provider Demographics
NPI:1225182603
Name:RILEY, KAREN RAINES (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RAINES
Last Name:RILEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2643 S. FLORENCE DR.
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-5738
Mailing Address - Country:US
Mailing Address - Phone:918-625-2322
Mailing Address - Fax:918-622-6209
Practice Address - Street 1:5970 E 31ST ST
Practice Address - Street 2:SUITE F
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-5100
Practice Address - Country:US
Practice Address - Phone:918-625-2322
Practice Address - Fax:918-622-6209
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2762235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1006424608Medicaid