Provider Demographics
NPI:1770608515
Name:RIEDL, KELLI
Entity type:Individual
Prefix:MS
First Name:KELLI
Middle Name:
Last Name:RIEDL
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 1:3246 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-7323
Mailing Address - Country:US
Mailing Address - Phone:614-451-0176
Mailing Address - Fax:614-451-8138
Practice Address - Street 1:3246 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-7323
Practice Address - Country:US
Practice Address - Phone:614-451-0176
Practice Address - Fax:614-451-8138
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent