Provider Demographics
NPI:1609933720
Name:RIVAS, AMELIA V (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:V
Last Name:RIVAS
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4179 PIEDMONT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5187
Mailing Address - Country:US
Mailing Address - Phone:510-333-4579
Mailing Address - Fax:510-740-3491
Practice Address - Street 1:4179 PIEDMONT AVE STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5187
Practice Address - Country:US
Practice Address - Phone:510-333-4579
Practice Address - Fax:510-740-3491
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27316235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist