Individual
TARA RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2500
(217) 383-6792
(217) 383-6792
Mailing address
611 W PARK ST, URBANA, IL 61801-2500
(217) 383-6792
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301014898
MI
Other
Enumeration date
04/26/2013
Last updated
12/10/2013
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