Provider Demographics
NPI:1366749830
Name:RIEDEMANN, PAT ANN (IADC, LBSW)
Entity type:Individual
Prefix:MS
First Name:PAT
Middle Name:ANN
Last Name:RIEDEMANN
Suffix:
Gender:F
Credentials:IADC, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 29TH ST
Mailing Address - Street 2:SUITE 319
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3852
Mailing Address - Country:US
Mailing Address - Phone:402-494-4904
Mailing Address - Fax:402-494-1210
Practice Address - Street 1:1000 W 29TH ST
Practice Address - Street 2:SUITE 319
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3852
Practice Address - Country:US
Practice Address - Phone:402-494-4904
Practice Address - Fax:402-494-1210
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE893101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)