Provider Demographics
NPI:1619503851
Name:RILEY, LINDA ANN
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:ANN
Last Name:RILEY
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 1:300 PARKWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4143
Mailing Address - Country:US
Mailing Address - Phone:410-294-8998
Mailing Address - Fax:
Practice Address - Street 1:6 PELICAN CT
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-1864
Practice Address - Country:US
Practice Address - Phone:410-294-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2024235Z00000X
NH1203235Z00000X
MA3797235Z00000X
MD02698235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist