Provider Demographics
NPI:1932566841
Name:FARR, RYLY (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RYLY
Middle Name:
Last Name:FARR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:MISS
Other - First Name:RYLY
Other - Middle Name:
Other - Last Name:SHUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:20650 GLENN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2324
Mailing Address - Country:US
Mailing Address - Phone:402-289-2579
Mailing Address - Fax:
Practice Address - Street 1:17830 SHADOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-2647
Practice Address - Country:US
Practice Address - Phone:402-637-0204
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2015003973235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$Medicaid