Individual
ANDRE RIDDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3680 PONY TRACKS DR, COLORADO SPRINGS, CO 80922-3062
(719) 654-4143
Mailing address
3680 PONY TRACKS DR, COLORADO SPRINGS, CO 80922-3062
(719) 654-4143
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-295673
CO
Other
Enumeration date
09/01/2023
Last updated
09/01/2023
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