Individual
JERILYNN RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1201 FIRST STREET SOUTH, WINTER HAVEN, FL 33880
(863) 297-1702
(863) 291-6084
Mailing address
200 AVENUE F NE, WINTER HAVEN, FL 33881
(863) 293-1121
(863) 291-6084
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MH4552
FL
Other
Enumeration date
08/19/2006
Last updated
07/08/2007
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