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General NPI Number Information
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NPI Number | 1629151782
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Entity Type | Individual
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Provider Name | KEVIN JOHN RIESER MA CCCA
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 908 ROCKBRIDGE RD
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City | NAPERVILLE
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State | IL
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Zip | 60540-8340
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Country | US
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Telephone | 630-428-3450
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Fax | 630-428-3450
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Provider Business Mailing Address
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Address Line | 908 ROCKBRIDGE RD
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City | NAPERVILLE
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State | IL
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Zip | 60540-8340
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Country | US
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Telephone | 630-428-3450
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Fax | 630-428-3450
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 147000915
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License Number State | IL
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