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NPI Code Detail

MEDICARE: KRISTIN LISA RIECK LPC

MEDICARE: KRISTIN LISA RIECK LPC
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
1101YM0800XMental Health CounselorC4635OR

General Provider Information

NPI Number : 1891208815
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN LISA RIECK LPC
Provider Business Mailing Address
First Line : 2367 STATE ST NE SUITE 100
Second Line :
City : SALEM
State : OR
Zip : 97301
Country : US
Telephone Number : 503-505-9161
Fax Number :
Provider Business Practice Location Address
First Line : 2367 STATE ST NE STE 100
Second Line :
City : SALEM
State : OR
Zip : 97301-4505
Country : US
Telephone Number : 503-505-9161
Fax Number : 503-540-4097
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2017
Last Update Date : 11/13/2017

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Directions to “ KRISTIN LISA RIECK LPC” Practice Location

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