Provider Demographics
NPI:1538817770
Name:RIVES, LEAH RACHEL (BS, HIS)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:RACHEL
Last Name:RIVES
Suffix:
Gender:F
Credentials:BS, HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5936 REIGER AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-4791
Mailing Address - Country:US
Mailing Address - Phone:214-502-3055
Mailing Address - Fax:
Practice Address - Street 1:1027 NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-5831
Practice Address - Country:US
Practice Address - Phone:214-703-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80842237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80842OtherTEXAS DEPARTMENT OF LICENSING AND REGISTRATION