MEDICARE: MS. PAT ANN RIEDEMANN IADC, LBSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	893	NE

General Provider Information

NPI Number	:	1366749830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAT ANN RIEDEMANN IADC, LBSW

Provider Business Mailing Address
First Line	:	1000 W 29TH ST
Second Line	:	SUITE 319
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776-3852
Country	:	US
Telephone Number	:	402-494-4904
Fax Number	:	402-494-1210

Provider Business Practice Location Address
First Line	:	1000 W 29TH ST
Second Line	:	SUITE 319
City	:	SOUTH SIOUX CITY
State	:	NE
Zip	:	68776-3852
Country	:	US
Telephone Number	:	402-494-4904
Fax Number	:	402-494-1210

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2011
Last Update Date	:	02/18/2011

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