Healthcare Provider Details

I. General information

NPI: 1962519215
Provider Name (Legal Business Name): ROBERT L RIEGERT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 DEWEY AVE LORTON II
WAUWATOSA WI
53213-2504
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-454-6500
  • Fax: 414-454-6527
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1880-123
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: