Provider Demographics
NPI:1609658699
Name:RIEDEL, SCOTT FISCHER (ND)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:FISCHER
Last Name:RIEDEL
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12084 SE 116TH CT
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-9604
Mailing Address - Country:US
Mailing Address - Phone:503-347-7161
Mailing Address - Fax:
Practice Address - Street 1:12084 SE 116TH CT
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-9604
Practice Address - Country:US
Practice Address - Phone:503-347-7161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5019175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath