MEDICARE: DR. APRIL RIEVESCHL PH.D.

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	103TC0700X	Clinical Psychologist	394	LA

General Provider Information

NPI Number	:	1699804922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. APRIL RIEVESCHL PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 2005
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-2005
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 GULF RIDGE DR
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-5738
Country	:	US
Telephone Number	:	850-231-5485
Fax Number	:

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

Provider Enumeration Date	:	03/04/2007
Last Update Date	:	12/28/2007

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