Healthcare Provider Details

I. General information

NPI: 1952432643
Provider Name (Legal Business Name): CARICE RENEE RIEMANN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 W LOMBARD ST
SPRINGFIELD MO
65806-2720
US

IV. Provider business mailing address

389 N NIANGUA DR
NIXA MO
65714-8785
US

V. Phone/Fax

Practice location:
  • Phone: 417-865-1646
  • Fax: 417-866-1483
Mailing address:
  • Phone: 785-218-7972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011011551
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: