Provider Demographics
NPI:1740415322
Name:RIEDEMANN, BROOKE ANN (BS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:RIEDEMANN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4689 TANAGER AVE
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:IA
Mailing Address - Zip Code:51058-7574
Mailing Address - Country:US
Mailing Address - Phone:712-221-9114
Mailing Address - Fax:712-255-0354
Practice Address - Street 1:921 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1031
Practice Address - Country:US
Practice Address - Phone:712-255-0232
Practice Address - Fax:712-255-0354
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)