Provider Demographics
NPI:1821237090
Name:RIEMANN, DEBBRA
Entity type:Individual
Prefix:
First Name:DEBBRA
Middle Name:
Last Name:RIEMANN
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:PO BOX 81232
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48308-1232
Mailing Address - Country:US
Mailing Address - Phone:248-929-5354
Mailing Address - Fax:
Practice Address - Street 1:1460 WALTON BLVD STE 218
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1779
Practice Address - Country:US
Practice Address - Phone:248-929-5354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52836106H00000X
CO.0001320106H00000X
MI4101006638106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92069ZOtherMEDICARE GROUP PTAN ID#
CAZZZ91891ZOtherMEDICARE GROUP PTAN ID#
CAZZZ91892ZOtherMEDICARE GROUP PTAN ID#