Provider Demographics
NPI:1174704308
Name:RISDON, KEVIN ALAN (CCC SLP)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALAN
Last Name:RISDON
Suffix:
Gender:M
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2371 VEEDOL DR
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-9020
Mailing Address - Country:US
Mailing Address - Phone:509-669-2025
Mailing Address - Fax:
Practice Address - Street 1:2371 VEEDOL DR
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-9020
Practice Address - Country:US
Practice Address - Phone:509-669-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60271740611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist