Provider Demographics
NPI:1699318097
Name:RISELING, CARRIE MICHELLE
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:MICHELLE
Last Name:RISELING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E GREGORY BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1117
Mailing Address - Country:US
Mailing Address - Phone:816-474-3995
Mailing Address - Fax:
Practice Address - Street 1:7 E GREGORY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1117
Practice Address - Country:US
Practice Address - Phone:816-474-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-18
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician