Provider Demographics
NPI:1316405491
Name:QUEZADA, RILEY ELIZABETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RILEY
Middle Name:ELIZABETH
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MRS
Other - First Name:RILEY
Other - Middle Name:ELIZABETH
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:3231 WILLAMETTE DR NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-1378
Mailing Address - Country:US
Mailing Address - Phone:360-489-6485
Mailing Address - Fax:
Practice Address - Street 1:3231 WILLAMETTE DR NE
Practice Address - Street 2:SUITE C
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-1378
Practice Address - Country:US
Practice Address - Phone:360-489-6485
Practice Address - Fax:844-452-1758
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL61398094235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist