Provider Demographics
NPI:1184436792
Name:RIETZ, ANGEL JO
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:JO
Last Name:RIETZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 WILKINS CIR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1336
Mailing Address - Country:US
Mailing Address - Phone:307-237-9583
Mailing Address - Fax:
Practice Address - Street 1:1430 WILKINS CIR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1336
Practice Address - Country:US
Practice Address - Phone:307-237-9583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106049008Medicaid
WY106049000Medicaid