Provider Demographics
NPI:1891313839
Name:PHILLIPS, RILEY MAKENNA (CF-SLP)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:MAKENNA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24551 DEL PRADO # 4154
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-9998
Mailing Address - Country:US
Mailing Address - Phone:909-747-4298
Mailing Address - Fax:
Practice Address - Street 1:439 N EL CAMINO REAL STE D
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4700
Practice Address - Country:US
Practice Address - Phone:909-747-4298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14552235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist