MEDICARE: RILEIGH MAYNARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SLPI.SI.70044563	WA

General Provider Information

NPI Number	:	1336006394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEIGH MAYNARD

Provider Business Mailing Address
First Line	:	216 W FLEMING AVE
Second Line	:
City	:	COLBERT
State	:	WA
Zip	:	99005-9674
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2218 N MOLTER RD
Second Line	:
City	:	LIBERTY LAKE
State	:	WA
Zip	:	99019-8603
Country	:	US
Telephone Number	:	509-558-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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Directions to “ RILEIGH MAYNARD ” Practice Location

Language	Start Address	Practice Location

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