Provider Demographics
NPI:1568241123
Name:BJAZEVICH, RILEY KRISTINE
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:KRISTINE
Last Name:BJAZEVICH
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 1:6234 W BIRCH RUN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-1277
Mailing Address - Country:US
Mailing Address - Phone:509-539-6045
Mailing Address - Fax:
Practice Address - Street 1:4095 E PONY EXPRESS PKWY STE 12
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-5531
Practice Address - Country:US
Practice Address - Phone:509-539-6045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist