Provider Demographics
NPI:1265194153
Name:RIECHES, SAMANTHA
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:RIECHES
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 1:1 EAGLE BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61858-6205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 W MULBERRY ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IL
Practice Address - Zip Code:61846-1897
Practice Address - Country:US
Practice Address - Phone:447-777-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.006558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2520987OtherPEL