Provider Demographics
NPI:1033740394
Name:RIEDERER, ANDREW QUINN (MT-BC, WMTR, NMT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:QUINN
Last Name:RIEDERER
Suffix:
Gender:M
Credentials:MT-BC, WMTR, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 HERITAGE BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:WEST SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:54669
Mailing Address - Country:US
Mailing Address - Phone:608-780-4327
Mailing Address - Fax:
Practice Address - Street 1:1537 HERITAGE BOULEVARD
Practice Address - Street 2:
Practice Address - City:WEST SALEM
Practice Address - State:WI
Practice Address - Zip Code:54669
Practice Address - Country:US
Practice Address - Phone:608-780-4327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10534225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist