Provider Demographics
NPI:1699462259
Name:RIISE, HEGE (PHD, LP)
Entity type:Individual
Prefix:DR
First Name:HEGE
Middle Name:
Last Name:RIISE
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 JASMINE POND DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-8103
Mailing Address - Country:US
Mailing Address - Phone:618-319-1520
Mailing Address - Fax:
Practice Address - Street 1:8708 JASMINE POND DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-8103
Practice Address - Country:US
Practice Address - Phone:618-319-1520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9669103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist