Provider Demographics
NPI:1629488846
Name:TERRY, RILEY M (AUD)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:M
Last Name:TERRY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:M
Other - Last Name:BASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2501 COTTONTAIL LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5125
Mailing Address - Country:US
Mailing Address - Phone:732-529-7120
Mailing Address - Fax:207-226-2064
Practice Address - Street 1:3120 S RAINBOW BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6235
Practice Address - Country:US
Practice Address - Phone:702-233-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-28
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5503231H00000X
NVA-2488231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist