Provider Demographics
NPI:1922608124
Name:RILEY, KRISTEN LAUREN (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LAUREN
Last Name:RILEY
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1805
Mailing Address - Country:US
Mailing Address - Phone:608-330-2253
Mailing Address - Fax:
Practice Address - Street 1:2100 E LAKE COOK RD STE 1000
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1999
Practice Address - Country:US
Practice Address - Phone:224-632-5600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI723156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist