Organization
MARY B RIEDEL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY B RIEDEL LPC (LICENSED PROFESSIONAL COUNSELOR)
(608) 799-1208
Entity
Organization
Contact information
Practice address
115 5TH AVE S, SUITE 301, LA CROSSE, WI 54601-9200
(608) 799-1208
Mailing address
317 GRANT ST, HOLMEN, WI 54636-8614
(608) 799-1208
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4671-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100029060
—
WI
Enumeration date
04/14/2014
Last updated
04/14/2014
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