Provider Demographics
NPI:1346433141
Name:RIECK, EVA MARIE (MA, CCC SP)
Entity Type:Individual
Prefix:MRS
First Name:EVA MARIE
Middle Name:
Last Name:RIECK
Suffix:
Gender:F
Credentials:MA, CCC SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 LAUREL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-9581
Mailing Address - Country:US
Mailing Address - Phone:937-339-3484
Mailing Address - Fax:
Practice Address - Street 1:1675 LAUREL CREEK DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-9581
Practice Address - Country:US
Practice Address - Phone:937-339-3484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3169235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist