Active NPI
Alexandra Riddick
- Speech-Language Pathologist
- Watkinsville, GA
National Provider Identifier
1417525155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP011198
- Practice address
- 1071 Thomas Ave
Watkinsville, GA 30677-6073 - Phone
- (770) 207-6390
- NPI assigned
- Jun 17, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP011198 | GA | Primary |
Addresses
Primary practice location
1071 Thomas Ave
Watkinsville, GA 30677-6073
Mailing address
1071 Thomas Ave
Watkinsville, GA 30677-6073
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SLP011198 | Other | PROFESSIONAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP011198 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623888000000",
"number": "1417525155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1071 THOMAS AVE",
"city": "WATKINSVILLE",
"state": "GA",
"postal_code": "306776073"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1071 THOMAS AVE",
"city": "WATKINSVILLE",
"state": "GA",
"postal_code": "306776073",
"telephone_number": "770-207-6390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDDICK",
"first_name": "ALEXANDRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-17",
"last_updated": "2021-06-17",
"certification_date": "2021-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP011198",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PROFESSIONAL LICENSE",
"identifier": "SLP011198",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Watkinsville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.