Provider Demographics
NPI:1760234413
Name:RILEY, TRENEIKEIA NELSHANDREA
Entity Type:Individual
Prefix:
First Name:TRENEIKEIA
Middle Name:NELSHANDREA
Last Name:RILEY
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 1:1551 W 90TH ST # 3W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-5165
Mailing Address - Country:US
Mailing Address - Phone:773-458-3151
Mailing Address - Fax:
Practice Address - Street 1:4945 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3825
Practice Address - Country:US
Practice Address - Phone:630-426-9386
Practice Address - Fax:773-523-3222
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty