Provider Demographics
NPI:1295027670
Name:RILEY, ANNE MARIE (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:RILEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:LAMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:1738 DURKEES FERRY RD
Mailing Address - Street 2:
Mailing Address - City:WEST TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47885
Mailing Address - Country:US
Mailing Address - Phone:812-535-3171
Mailing Address - Fax:
Practice Address - Street 1:375 S 11TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-1053
Practice Address - Country:US
Practice Address - Phone:765-832-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004857A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist