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General NPI Number Information
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NPI Number | 1164331518
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Entity Type | Individual
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Provider Name | JASON D RIEKER
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Gender | Male
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 253 LOWER PRAIRIE DOG RD
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City | SHERIDAN
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State | WY
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Zip | 82801-9636
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Country | US
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Telephone | 623-910-7688
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Fax |
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Provider Business Mailing Address
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Address Line | 253 LOWER PRAIRIE DOG RD
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City | SHERIDAN
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State | WY
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Zip | 82801-9636
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Country | US
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Telephone | 623-910-7688
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Fax |
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State | WY
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