Healthcare Provider Details

I. General information

NPI: 1730120932
Provider Name (Legal Business Name): AMY J RIESE MS CCC - SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 381
OCOEE FL
34761-3435
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 381
OCOEE FL
34761-3435
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-1900
  • Fax: 321-843-8771
Mailing address:
  • Phone: 407-296-1900
  • Fax: 321-843-8771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1431-154
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: