Healthcare Provider Details

I. General information

NPI: 1265287676
Provider Name (Legal Business Name): RILEY RODEMAKER LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2024
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 N ANKENY BLVD STE 100
ANKENY IA
50023-4003
US

IV. Provider business mailing address

1900 SILVER LAKE RD NW STE 110
NEW BRIGHTON MN
55112-1789
US

V. Phone/Fax

Practice location:
  • Phone: 515-255-8399
  • Fax: 515-644-8225
Mailing address:
  • Phone: 651-628-9566
  • Fax: 651-628-0411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number125942
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: