Provider Demographics
NPI:1356998819
Name:RIDDICK, DARIAN PAIGE (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:DARIAN
Middle Name:PAIGE
Last Name:RIDDICK
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18002 RICHMOND PLACE DR APT 515
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1726
Mailing Address - Country:US
Mailing Address - Phone:304-561-8645
Mailing Address - Fax:
Practice Address - Street 1:5245 N SOCRUM LOOP RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-4253
Practice Address - Country:US
Practice Address - Phone:863-859-1446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty