MEDICARE: JEFF GERRIT RIETBERG MHP

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1689146169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF GERRIT RIETBERG MHP

Provider Business Mailing Address
First Line	:	9725 3RD AVE NE STE 300
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9725 3RD AVE NE STE 300
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2030
Country	:	US
Telephone Number	:	206-461-3210
Fax Number	:

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

Provider Enumeration Date	:	12/21/2018
Last Update Date	:	12/21/2018

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