Provider Demographics
NPI:1366659765
Name:RILEY, ANNA L (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:RILEY
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1238 OLD NAZARETH RD
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9475
Mailing Address - Country:US
Mailing Address - Phone:502-348-8511
Mailing Address - Fax:
Practice Address - Street 1:1238 OLD NAZARETH RD
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-9475
Practice Address - Country:US
Practice Address - Phone:502-348-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist