Miranda Mae Riddle, MS., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.016080 Issued in IL

Practice address

12505 N 1500TH Rd
Macomb, IL 61455-8425

Phone

(325) 212-3239

NPI assigned

Aug 30, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL, FL2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Trinity Speech Services LLC

  • Speech-Language Pathologist
  • Macomb, IL
  • NPI 1538899430

  FL

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1407524168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12505 N 1500TH RD",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614558425",
            "telephone_number": "325-212-3239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12505 N 1500TH RD",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614558425",
            "telephone_number": "325-212-3239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDLE",
        "first_name": "MIRANDA",
        "middle_name": "MAE",
        "credential": "MS., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-30",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146016080",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "114598",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.016080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "EHRElectronicRecords",
            "affiliation": "N",
            "endpointDescription": "Electronic Records",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "EHR Electronic Records",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "EHR",
            "address_1": "12505 N 1500th Rd",
            "city": "Macomb",
            "state": "IL",
            "country_code": "US",
            "postal_code": "614558425",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lacey Nicole Remington, SSP
• Remlo
• Max Ronald Rexroat, DPM
• Christie S Reynolds, LCPC
• Victoria Claire Richards, COTA/L
• Ronald E Rigdon, M.D.
• Cathy Elaine Rigg, MSW, LCSW
• Emily Sellers Roberts, L.C.P.C.
• Jamal Robinson
• Robyn Alley-Hay, M.D. Woman to Woman

• Speech-Language Pathologist in Macomb, IL
• Providers in Macomb, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.