Provider Demographics
NPI:1184010175
Name:RILEY, TAWNA JEAN (LMSW)
Entity Type:Individual
Prefix:
First Name:TAWNA
Middle Name:JEAN
Last Name:RILEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:TAWNA
Other - Middle Name:JEAN
Other - Last Name:DITMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 E INDIAN SCHOOL RD
Mailing Address - Street 2:PHOENIX VA CLC
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1845
Mailing Address - Country:US
Mailing Address - Phone:602-244-5551
Mailing Address - Fax:602-212-2114
Practice Address - Street 1:605 E INDIAN SCHOOL RD
Practice Address - Street 2:PHOENIX VA CLC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1845
Practice Address - Country:US
Practice Address - Phone:602-244-5551
Practice Address - Fax:602-212-2114
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW15377104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker