Provider Demographics
NPI:1871639203
Name:RIEDEL, JAMES S (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:S
Last Name:RIEDEL
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7425 JANES AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2356
Mailing Address - Country:US
Mailing Address - Phone:630-852-8451
Mailing Address - Fax:630-852-0554
Practice Address - Street 1:7425 JANES AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2356
Practice Address - Country:US
Practice Address - Phone:630-852-8451
Practice Address - Fax:630-852-0554
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL360340Medicare ID - Type Unspecified