Provider Demographics
NPI:1578867131
Name:RIECKE, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:RIECKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1749
Mailing Address - Country:US
Mailing Address - Phone:570-586-2222
Mailing Address - Fax:570-585-1321
Practice Address - Street 1:718 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1749
Practice Address - Country:US
Practice Address - Phone:570-586-2222
Practice Address - Fax:570-585-1321
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist