Provider Demographics
NPI:1487272639
Name:LISA RIDINGER PC
Entity type:Organization
Organization Name:LISA RIDINGER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-277-9465
Mailing Address - Street 1:100 W ROOSEVELT RD STE B5-201
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5298
Mailing Address - Country:US
Mailing Address - Phone:630-277-9465
Mailing Address - Fax:
Practice Address - Street 1:100 W ROOSEVELT RD STE B5-201
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5298
Practice Address - Country:US
Practice Address - Phone:630-277-9465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty