Provider Demographics
NPI:1144456138
Name:RIESER, KAREN L (SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:RIESER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 RAVENWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:BARNEGAT
Mailing Address - State:NJ
Mailing Address - Zip Code:08005-2041
Mailing Address - Country:US
Mailing Address - Phone:908-421-5189
Mailing Address - Fax:609-488-5168
Practice Address - Street 1:124 RAVENWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BARNEGAT
Practice Address - State:NJ
Practice Address - Zip Code:08005-2041
Practice Address - Country:US
Practice Address - Phone:908-421-5189
Practice Address - Fax:609-488-5168
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00401700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist