Provider Demographics
NPI:1629292214
Name:RILEY, LOUISE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 MERIDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5835
Mailing Address - Country:US
Mailing Address - Phone:267-738-9800
Mailing Address - Fax:
Practice Address - Street 1:1003 MERIDIAN WAY
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5835
Practice Address - Country:US
Practice Address - Phone:267-738-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL005594L235Z00000X
MESP846235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019329840003OtherPROMISE PROVIDER #