Provider Demographics
NPI:1316313240
Name:RIKER, KAILEY (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAILEY
Middle Name:
Last Name:RIKER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KAILEY
Other - Middle Name:
Other - Last Name:WASHBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1450 FARR RD STE 5000
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-7789
Mailing Address - Country:US
Mailing Address - Phone:231-739-9095
Mailing Address - Fax:
Practice Address - Street 1:1450 FARR RD STE 5000
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-7789
Practice Address - Country:US
Practice Address - Phone:231-739-9095
Practice Address - Fax:231-722-5147
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL535679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist