Provider Demographics
NPI:1407029481
Name:RIEDI, MATTHEW J (MS CCCA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:J
Last Name:RIEDI
Suffix:
Gender:M
Credentials:MS CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-4501
Mailing Address - Country:US
Mailing Address - Phone:920-432-7986
Mailing Address - Fax:
Practice Address - Street 1:111 S MADISON ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4501
Practice Address - Country:US
Practice Address - Phone:920-432-7986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI147-156231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41119400Medicaid