Provider Demographics
NPI:1326441304
Name:REDIGER, ELISE IRENE (LPC)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:IRENE
Last Name:REDIGER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:CO
Mailing Address - Zip Code:81425-0529
Mailing Address - Country:US
Mailing Address - Phone:970-323-6141
Mailing Address - Fax:855-299-8071
Practice Address - Street 1:308 MAIN ST.
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:CO
Practice Address - Zip Code:81425
Practice Address - Country:US
Practice Address - Phone:970-323-6141
Practice Address - Fax:855-299-8071
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0013634101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional