Provider Demographics
NPI:1801342852
Name:RIORDAN, MELISSA (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:LINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28646-0711
Mailing Address - Country:US
Mailing Address - Phone:828-260-0790
Mailing Address - Fax:
Practice Address - Street 1:64 HIGH COUNTRY SQ
Practice Address - Street 2:TYNCASTLE HWY S.R. 184
Practice Address - City:BANNER ELK
Practice Address - State:NC
Practice Address - Zip Code:28604-7705
Practice Address - Country:US
Practice Address - Phone:828-260-0790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5925235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist