Provider Demographics
NPI:1790905552
Name:RIEMAN, DEIRDRE ANN (MACCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:DEIRDRE
Middle Name:ANN
Last Name:RIEMAN
Suffix:
Gender:F
Credentials:MACCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W EDGEWATER ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7425
Mailing Address - Country:US
Mailing Address - Phone:918-455-4834
Mailing Address - Fax:
Practice Address - Street 1:600 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:OKEMAH
Practice Address - State:OK
Practice Address - Zip Code:74859
Practice Address - Country:US
Practice Address - Phone:918-623-1936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2151235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist