Provider Demographics
NPI:1841997541
Name:RIEDEL, COURTNEY LYNN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN
Last Name:RIEDEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31806 COTTAGE GROVE LORANE RD
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-9748
Mailing Address - Country:US
Mailing Address - Phone:503-420-9200
Mailing Address - Fax:
Practice Address - Street 1:219 42ND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97478-5937
Practice Address - Country:US
Practice Address - Phone:541-224-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician