Provider Demographics
NPI:1457662496
Name:RIDDLE, SAVRENA A (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SAVRENA
Middle Name:A
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 CONKLIN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-2614
Mailing Address - Country:US
Mailing Address - Phone:516-249-5477
Mailing Address - Fax:
Practice Address - Street 1:399 CONKLIN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2614
Practice Address - Country:US
Practice Address - Phone:516-249-5477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016559-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist