Provider Demographics
NPI:1952564635
Name:RILEY, JANET E (AUD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
Last Name:RILEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 SE HILLMOOR DR
Mailing Address - Street 2:SUITE B-105
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7553
Mailing Address - Country:US
Mailing Address - Phone:772-323-2174
Mailing Address - Fax:772-398-4374
Practice Address - Street 1:1801 SE HILLMOOR DR
Practice Address - Street 2:SUITE B-105
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7553
Practice Address - Country:US
Practice Address - Phone:772-323-2174
Practice Address - Fax:772-398-4374
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.01627231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAY1580OtherSTATE LICENSE NUMBER