Provider Demographics
NPI:1033493630
Name:RITTENBERRY, SUZANNE (LAC)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:RITTENBERRY
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 OLD BEE CAVES RD
Mailing Address - Street 2:TX
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-8234
Mailing Address - Country:US
Mailing Address - Phone:512-632-5795
Mailing Address - Fax:
Practice Address - Street 1:7413 OLD BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8234
Practice Address - Country:US
Practice Address - Phone:512-632-5795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01110171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist