Provider Demographics
NPI:1184756009
Name:RIECKS, BRUCE EDWARD (PSYD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:EDWARD
Last Name:RIECKS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17046 VINELAND DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7668
Mailing Address - Country:US
Mailing Address - Phone:303-870-3136
Mailing Address - Fax:
Practice Address - Street 1:5500 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8201
Practice Address - Country:US
Practice Address - Phone:303-723-5902
Practice Address - Fax:303-797-9354
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO303770OtherMEDICARE INDIVIDUAL PTAN