Provider Demographics
NPI:1689911216
Name:RIESCHE, JAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:
Last Name:RIESCHE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15248 BELLE FORCH CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1023
Mailing Address - Country:US
Mailing Address - Phone:317-797-7816
Mailing Address - Fax:317-844-4585
Practice Address - Street 1:25 BEACHWAY DR
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-8506
Practice Address - Country:US
Practice Address - Phone:317-788-4111
Practice Address - Fax:317-788-7783
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001464A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical