Healthcare Provider Details

I. General information

NPI: 1457268088
Provider Name (Legal Business Name): ANDREA RISKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W PARK PL STE 202
COEUR D ALENE ID
83814-2783
US

IV. Provider business mailing address

2131 E DALTON AVE
DALTON GARDENS ID
83815-9614
US

V. Phone/Fax

Practice location:
  • Phone: 208-244-0120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: