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General NPI Number Information
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NPI Number | 1154528164
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Entity Type | Individual
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Provider Name | ELIZABETH DEY RIDDLE M.A.,CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2201 11TH AVE
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City | HALEYVILLE
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State | AL
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Zip | 35565-1613
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Country | US
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Telephone | 205-486-9478
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Fax | 205-486-8738
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Provider Business Mailing Address
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Address Line | 5997 DIME RD
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City | HALEYVILLE
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State | AL
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Zip | 35565-6907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2193
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License Number State | AL
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