Provider Demographics
NPI:1609399625
Name:RILEY, VICKI LYNN (LPC-IT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:LYNN
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14301 COUNTY HIGHWAY B BLDG A19
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:WI
Mailing Address - Zip Code:54656-4509
Mailing Address - Country:US
Mailing Address - Phone:608-269-8624
Mailing Address - Fax:608-269-8935
Practice Address - Street 1:14301 COUNTY HIGHWAY B BLDG A19
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:WI
Practice Address - Zip Code:54656-0044
Practice Address - Country:US
Practice Address - Phone:608-269-8624
Practice Address - Fax:608-269-8935
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2688-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional