Provider Demographics
NPI:1649794892
Name:RIEDSTRA, KARA (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:
Last Name:RIEDSTRA
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1522
Mailing Address - Country:US
Mailing Address - Phone:815-928-7001
Mailing Address - Fax:
Practice Address - Street 1:84 N OAK ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1522
Practice Address - Country:US
Practice Address - Phone:815-928-7001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-31
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist