MEDICARE: DR. JAN LOUIS 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	389	LA

General Provider Information

NPI Number	:	1770631814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAN LOUIS RIEVESCHL PH.D.

Provider Business Mailing Address
First Line	:	1419 AMELIA ST
Second Line	:	SUITE #1
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-3624
Country	:	US
Telephone Number	:	504-895-6524
Fax Number	:	504-896-4977

Provider Business Practice Location Address
First Line	:	1419 AMELIA ST
Second Line	:	SUITE #1
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-3624
Country	:	US
Telephone Number	:	504-895-6524
Fax Number	:	504-896-4977

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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