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General NPI Number Information
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NPI Number | 1043377120
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Entity Type | Individual
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Provider Name | CHRISTINA ELLA EMDE RILEY L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 158 N ORTH FIRST EAST STREET
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City | DRIGGS
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State | ID
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Zip | 83422
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Country | US
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Telephone | 307-730-7060
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Fax | 208-787-5683
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Provider Business Mailing Address
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Address Line | 163 E 1025 S
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City | VICTOR
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State | ID
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Zip | 83455-5503
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Country | US
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Telephone | 307-730-7060
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Fax | 208-787-5683
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-26777
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-377
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License Number State | WY
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