MEDICARE: MS. SALLY SUE RILEY CD(DONA), CCE, CLE,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1407627516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SALLY SUE RILEY CD(DONA), CCE, CLE,

Provider Business Mailing Address
First Line	:	9167 W 92ND TER
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66212-3914
Country	:	US
Telephone Number	:	913-341-2853
Fax Number	:

Provider Business Practice Location Address
First Line	:	9167 W 92ND TER
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66212-3914
Country	:	US
Telephone Number	:	913-341-2853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	01/09/2024

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