1699409177 NPI number — MRS. RILEY EASON MCDANIEL MA/CCC-SLP

Table of content: MRS. RILEY EASON MCDANIEL MA/CCC-SLP (NPI 1699409177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699409177 NPI number — MRS. RILEY EASON MCDANIEL MA/CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCDANIEL
Provider First Name:
RILEY
Provider Middle Name:
EASON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA/CCC-SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EASON
Provider Other First Name:
RILEY
Provider Other Middle Name:
COLLEEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, CF-SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1699409177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
399 JENKINS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANSFIELD
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71052-3128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-872-1198
Provider Business Mailing Address Fax Number:
318-872-6501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2535 HIGHWAY 171
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STONEWALL
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71078-9423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-925-1610
Provider Business Practice Location Address Fax Number:
318-925-2970
Provider Enumeration Date:
07/12/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  9092 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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