Doctor Name: | MR. CASEY RIDER |
NPI Number: | 1235367079 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 11221 |
Business Practice Address: | 280 W Macarthur Blvd Oakland, CA - 946115642 |
Business Phone Number: | 5107521000 |
Business Fax Number: | |
Mailing Address: | 36 Alta Vista Way, SAN RAFAEL |
State: | CA |
Postal Code: | 949013517 |
Phone Number: | 4154655765 |
Fax Number: | |
NPI Enumeration Date: | 07/01/2009 |
NPI Last Update Date: | 07/01/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 11221 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |