Provider Demographics
NPI:1063562429
Name:RIEDINGER, DEBRA KAY (MA, LLP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:KAY
Last Name:RIEDINGER
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 ASHMAN ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-5470
Mailing Address - Country:US
Mailing Address - Phone:989-832-9161
Mailing Address - Fax:989-832-8813
Practice Address - Street 1:1108 ASHMAN ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-5470
Practice Address - Country:US
Practice Address - Phone:989-832-9161
Practice Address - Fax:989-832-8813
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005762103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral