Provider Demographics
NPI:1699409177
Name:MCDANIEL, RILEY EASON (MA/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RILEY
Middle Name:EASON
Last Name:MCDANIEL
Suffix:
Gender:F
Credentials:MA/CCC-SLP
Other - Prefix:MS
Other - First Name:RILEY
Other - Middle Name:COLLEEN
Other - Last Name:EASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CF-SLP
Mailing Address - Street 1:399 JENKINS ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:71052-3128
Mailing Address - Country:US
Mailing Address - Phone:318-872-1198
Mailing Address - Fax:318-872-6501
Practice Address - Street 1:2535 HIGHWAY 171
Practice Address - Street 2:
Practice Address - City:STONEWALL
Practice Address - State:LA
Practice Address - Zip Code:71078-9423
Practice Address - Country:US
Practice Address - Phone:318-925-1610
Practice Address - Fax:318-925-2970
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-12
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9092235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty