Provider Demographics
NPI:1992568950
Name:RIDER, ELIZABETH S (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:RIDER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WILD ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7720
Mailing Address - Country:US
Mailing Address - Phone:802-324-6227
Mailing Address - Fax:
Practice Address - Street 1:104 WILD ROSE CIR
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7720
Practice Address - Country:US
Practice Address - Phone:802-324-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT144.0115187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist