Provider Demographics
NPI:1467026765
Name:RIVAS, DESIREE ASHLEY (MS)
Entity Type:Individual
Prefix:MS
First Name:DESIREE
Middle Name:ASHLEY
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16830 S ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8218
Mailing Address - Country:US
Mailing Address - Phone:708-822-4542
Mailing Address - Fax:
Practice Address - Street 1:16830 S ASHLEY CT
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8218
Practice Address - Country:US
Practice Address - Phone:708-822-4542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist