Healthcare Provider Details

I. General information

NPI: 1053730697
Provider Name (Legal Business Name): LOIS RIDEN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SCHOOL ST
HUNTINGTON VT
05462-9795
US

IV. Provider business mailing address

410 LAVALLEE DR
RICHMOND VT
05477-8815
US

V. Phone/Fax

Practice location:
  • Phone: 802-434-2074
  • Fax:
Mailing address:
  • Phone: 802-434-2342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: