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NPI Code Detail

MEDICARE: CLAIRE ELIZABETH RIDDIOUGH MSW, LCSW

MEDICARE: CLAIRE ELIZABETH RIDDIOUGH MSW, LCSW
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
1101YA0400XAddiction (Substance Use Disorder) CounselorWI
21041C0700XClinical Social Worker9634WI

General Provider Information

NPI Number : 1427549815
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLAIRE ELIZABETH RIDDIOUGH MSW, LCSW
Provider Business Mailing Address
First Line : 200 W VERONA AVE
Second Line :
City : VERONA
State : WI
Zip : 53593-1394
Country : US
Telephone Number : 608-291-6184
Fax Number :
Provider Business Practice Location Address
First Line : 200 W VERONA AVE
Second Line :
City : VERONA
State : WI
Zip : 53593-1394
Country : US
Telephone Number : 608-347-5746
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2018
Last Update Date : 09/21/2023

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