Provider Demographics
NPI:1003901562
Name:RIDEOUT, KENNETH CHARLES (M ED)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CHARLES
Last Name:RIDEOUT
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:321 EAST 5TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15208
Mailing Address - Country:US
Mailing Address - Phone:724-226-0664
Mailing Address - Fax:724-226-4865
Practice Address - Street 1:321 EAST 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15208
Practice Address - Country:US
Practice Address - Phone:724-226-0664
Practice Address - Fax:724-226-4865
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)