Provider Demographics
NPI:1588879712
Name:RIVERO, ALEIDA M
Entity type:Individual
Prefix:
First Name:ALEIDA
Middle Name:M
Last Name:RIVERO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ALY
Other - Middle Name:M
Other - Last Name:RIVERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:2832 WINNERS CIR
Mailing Address - Street 2:
Mailing Address - City:JAX BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-1646
Mailing Address - Country:US
Mailing Address - Phone:904-894-6169
Mailing Address - Fax:
Practice Address - Street 1:12740 LANIER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32226-1704
Practice Address - Country:US
Practice Address - Phone:904-757-0600
Practice Address - Fax:888-421-1025
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOND 2007081 SP235Z00000X
OHSP.8944235Z00000X
FLSA12875235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP.8944OtherOHIO SPEECH-LANGUAGE PATHOLOGY LICENSE
12100681OtherASHA CERTIFICATE OF CLINICAL COMPETENCE
FLSA12875OtherFLORIDA SPEECH-LANGUAGE PATHOLOGY LICENSE