Provider Demographics
NPI:1629783899
Name:BURKHOLDER, RILEY JAYE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:JAYE
Last Name:BURKHOLDER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 FRANKLIN SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-1474
Mailing Address - Country:US
Mailing Address - Phone:717-860-9816
Mailing Address - Fax:
Practice Address - Street 1:111 CHAMBERS HILL DR
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-7304
Practice Address - Country:US
Practice Address - Phone:717-709-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016833235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist