Provider Demographics
NPI:1760887251
Name:RILEY, KENDRA LEIGH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:LEIGH
Last Name:RILEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:LEIGH
Other - Last Name:KOLMETZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14055 TOWN LOOP BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6105
Mailing Address - Country:US
Mailing Address - Phone:407-857-6285
Mailing Address - Fax:
Practice Address - Street 1:14055 TOWN LOOP BLVD
Practice Address - Street 2:STE 300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6105
Practice Address - Country:US
Practice Address - Phone:407-857-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12138235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist