Provider Demographics
NPI:1902583503
Name:RILEY, JOY DIANE COOKSEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:DIANE COOKSEY
Last Name:RILEY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 GHOLSON RD
Mailing Address - Street 2:
Mailing Address - City:WEST PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42086-9599
Mailing Address - Country:US
Mailing Address - Phone:270-933-8969
Mailing Address - Fax:
Practice Address - Street 1:100 KIANA CT APT A
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6767
Practice Address - Country:US
Practice Address - Phone:270-443-0681
Practice Address - Fax:270-538-9007
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY285581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist