Provider Demographics
NPI:1477834661
Name:RILEY, KATHRYN S (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:S
Last Name:RILEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 OAK TREE CIR
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-2170
Mailing Address - Country:US
Mailing Address - Phone:518-792-8879
Mailing Address - Fax:
Practice Address - Street 1:99 BUCKLEY RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:NY
Practice Address - Zip Code:12887-3633
Practice Address - Country:US
Practice Address - Phone:518-499-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009381-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009381-1OtherNEW YORK STATE OFFICE OF THE PROFESSIONS- LICENSE