Provider Demographics
NPI:1942393350
Name:RIESS, RHONDA RENEE (MED)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:RENEE
Last Name:RIESS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 OAK PL
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-8388
Mailing Address - Country:US
Mailing Address - Phone:850-305-4616
Mailing Address - Fax:
Practice Address - Street 1:407 OAK PL
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-8388
Practice Address - Country:US
Practice Address - Phone:850-305-4616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor