Provider Demographics
NPI:1467612655
Name:RIEGO, AMY KATHLEEN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:KATHLEEN
Last Name:RIEGO
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 1:1707 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2002
Mailing Address - Country:US
Mailing Address - Phone:317-415-5505
Mailing Address - Fax:
Practice Address - Street 1:1707 W 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2002
Practice Address - Country:US
Practice Address - Phone:317-415-5505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003709A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist