MEDICARE: RILEY MAKENNA PHILLIPS CF-SLP

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	14552	CA

General Provider Information

NPI Number	:	1891313839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY MAKENNA PHILLIPS CF-SLP

Provider Business Mailing Address
First Line	:	24551 DEL PRADO # 4154
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-9998
Country	:	US
Telephone Number	:	909-747-4298
Fax Number	:

Provider Business Practice Location Address
First Line	:	439 N EL CAMINO REAL STE D
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4700
Country	:	US
Telephone Number	:	909-747-4298
Fax Number	:

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

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	06/30/2022

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Directions to “ RILEY MAKENNA PHILLIPS CF-SLP” Practice Location

Language	Start Address	Practice Location

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