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General NPI Number Information
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NPI Number | 1760991525
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Entity Type | Individual
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Provider Name | JESSICA RIDDLE LLPC
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Gender | Female
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Dates
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Enumeration Date | 09/25/2017
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 1840 W HOUGHTON LAKE DR
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City | PRUDENVILLE
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State | MI
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Zip | 48651-9672
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Country | US
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Telephone | 989-390-9655
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Fax |
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Provider Business Mailing Address
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Address Line | 9249 W LAKE CITY RD
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City | HOUGHTON LAKE
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State | MI
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Zip | 48629-9602
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Country | US
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Telephone | 989-422-5122
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451024510
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License Number State | MI
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