Provider Demographics
NPI:1396316592
Name:RILEY, KELANDA QUEZELDA (BS, MSW, RSW)
Entity type:Individual
Prefix:
First Name:KELANDA
Middle Name:QUEZELDA
Last Name:RILEY
Suffix:
Gender:F
Credentials:BS, MSW, RSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 S EDWARD AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-3726
Mailing Address - Country:US
Mailing Address - Phone:225-647-1273
Mailing Address - Fax:
Practice Address - Street 1:415 COURT ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2747
Practice Address - Country:US
Practice Address - Phone:225-245-9070
Practice Address - Fax:225-245-9073
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator