Provider Demographics
NPI:1457423329
Name:RIEGG-LUEDGE, JOHANNA FRIEDA (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:FRIEDA
Last Name:RIEGG-LUEDGE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 CEDAR ST STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4369
Mailing Address - Country:US
Mailing Address - Phone:831-425-3179
Mailing Address - Fax:831-460-9558
Practice Address - Street 1:412 CEDAR ST STE A
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4369
Practice Address - Country:US
Practice Address - Phone:831-425-3179
Practice Address - Fax:831-460-9558
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL157540Medicare UPIN