Healthcare Provider Details

I. General information

NPI: 1184379513
Provider Name (Legal Business Name): JAVIER ANTONIO RIVERA MS, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 NE 12TH AVE
CRYSTAL RIVER FL
34429-4553
US

IV. Provider business mailing address

660 N HEATHROW DR
LECANTO FL
34461-8110
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-5044
  • Fax: 352-795-5848
Mailing address:
  • Phone: 352-462-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP15378
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA21164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: