Provider Demographics
NPI:1538315023
Name:RYAN-RIVERS, MICHELLE MELYNN (MS CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MELYNN
Last Name:RYAN-RIVERS
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 1:23 OSBORNE RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3443
Mailing Address - Country:US
Mailing Address - Phone:518-458-9545
Mailing Address - Fax:
Practice Address - Street 1:23 OSBORNE RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3443
Practice Address - Country:US
Practice Address - Phone:518-458-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3025-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist