Healthcare Provider Details

I. General information

NPI: 1598695736
Provider Name (Legal Business Name): RILEY DIETRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 STATE ROUTE 45 N
ROCK CREEK OH
44084-9352
US

IV. Provider business mailing address

2863 STATE ROUTE 45 N
ROCK CREEK OH
44084-9352
US

V. Phone/Fax

Practice location:
  • Phone: 440-563-3400
  • Fax:
Mailing address:
  • Phone: 440-563-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCAPRE.196049
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: