Individual
DR. JEREMY RIDDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RH
Contact information
Practice address
455 PORTLAND AVE, GLADSTONE, OR 97027-2452
(971) 404-6452
Mailing address
PO BOX 1002, GLADSTONE, OR 97027-3002
(971) 404-6452
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
—
374K00000X
Religious Nonmedical Practitioner
Primary
—
—
Other
Enumeration date
12/20/2019
Last updated
12/20/2019
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