Provider Demographics
NPI:1174166649
Name:MACKALL-CARNEY, RILEY S
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:S
Last Name:MACKALL-CARNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RILEY
Other - Middle Name:S
Other - Last Name:MACKALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3180 ARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-3701
Mailing Address - Country:US
Mailing Address - Phone:415-921-7658
Mailing Address - Fax:
Practice Address - Street 1:3180 ARDEN WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-3701
Practice Address - Country:US
Practice Address - Phone:415-921-7658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPE13565231H00000X
CAHA8485237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist