Provider Demographics
NPI:1396223046
Name:RIVERO, JAMIE MOLLOY (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MOLLOY
Last Name:RIVERO
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 1:2120 ARDEN CREEK WAY APT 5103
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8046
Mailing Address - Country:US
Mailing Address - Phone:262-347-7689
Mailing Address - Fax:
Practice Address - Street 1:1250 BRANCHLANDS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1703
Practice Address - Country:US
Practice Address - Phone:434-973-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-04
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9892235Z00000X
VA2202010032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist