MEDICARE: RILEY TANNER

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	235Z00000X	Speech-Language Pathologist	COND.20232407-SP	OH

General Provider Information

NPI Number	:	1700663952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY TANNER

Provider Business Mailing Address
First Line	:	10502 HOBBS STATION RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-2669
Country	:	US
Telephone Number	:	502-548-9093
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 W KEMPER RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-1699
Country	:	US
Telephone Number	:	513-619-2420
Fax Number	:

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

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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Directions to “ RILEY TANNER ” Practice Location

Language	Start Address	Practice Location

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