Provider Demographics
NPI:1841833597
Name:RIEDEL, MACKENZIE (SSP, NCSP)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:
Last Name:RIEDEL
Suffix:
Gender:F
Credentials:SSP, NCSP
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:RIEDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CRETE PUBLIC SCHOOLS
Mailing Address - Street 2:920 LINDEN AVE
Mailing Address - City:CRETE
Mailing Address - State:NE
Mailing Address - Zip Code:68333
Mailing Address - Country:US
Mailing Address - Phone:402-826-5228
Mailing Address - Fax:402-826-1086
Practice Address - Street 1:CRETE PUBLIC SCHOOLS
Practice Address - Street 2:920 LINDEN AVE
Practice Address - City:CRETE
Practice Address - State:NE
Practice Address - Zip Code:68333
Practice Address - Country:US
Practice Address - Phone:402-826-5228
Practice Address - Fax:402-826-1086
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2019012102103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool