Provider Demographics
NPI:1558676874
Name:RIDER, PATRICIA JEAN
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JEAN
Last Name:RIDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14280 RT. 42
Mailing Address - Street 2:
Mailing Address - City:EAGLES MERE
Mailing Address - State:PA
Mailing Address - Zip Code:17731-0129
Mailing Address - Country:US
Mailing Address - Phone:570-525-3644
Mailing Address - Fax:
Practice Address - Street 1:14280 RT. 42
Practice Address - Street 2:
Practice Address - City:EAGLES MERE
Practice Address - State:PA
Practice Address - Zip Code:17731-0129
Practice Address - Country:US
Practice Address - Phone:570-525-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL004997L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist