Healthcare Provider Details

I. General information

NPI: 1386232445
Provider Name (Legal Business Name): RILEY ANN SCHREDER JEPSEN MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RILEY ANN SCHREDER MA CCC-SLP

II. Dates (important events)

Enumeration Date: 01/05/2021
Last Update Date: 01/05/2021
Certification Date: 01/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14407 AURORA AVE
URBANDALE IA
50323-2689
US

IV. Provider business mailing address

14407 AURORA AVE
URBANDALE IA
50323-2689
US

V. Phone/Fax

Practice location:
  • Phone: 319-213-0305
  • Fax:
Mailing address:
  • Phone: 319-213-0305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number093449
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: