Provider Demographics
NPI:1639867971
Name:WADE, RILEY
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:WADE
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 1:1219 FALLS CREST PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-1529
Mailing Address - Country:US
Mailing Address - Phone:615-708-3993
Mailing Address - Fax:
Practice Address - Street 1:1415 RIDGEBACK RD STE 21
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-6984
Practice Address - Country:US
Practice Address - Phone:619-207-0984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist