Healthcare Provider Details

I. General information

NPI: 1457423329
Provider Name (Legal Business Name): JOHANNA FRIEDA RIEGG-LUEDGE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CEDAR ST STE A
SANTA CRUZ CA
95060-4369
US

IV. Provider business mailing address

412 CEDAR ST STE A
SANTA CRUZ CA
95060-4369
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-3179
  • Fax: 831-460-9558
Mailing address:
  • Phone: 831-425-3179
  • Fax: 831-460-9558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: