Provider Demographics
NPI:1194126912
Name:RIEDEL, ANNETTE (MED, EDS)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:MED, EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 HALL ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-9485
Mailing Address - Country:US
Mailing Address - Phone:419-867-5756
Mailing Address - Fax:419-867-5736
Practice Address - Street 1:6900 HALL ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-9485
Practice Address - Country:US
Practice Address - Phone:419-867-5756
Practice Address - Fax:419-867-5736
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTU1007101103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist