Provider Demographics
NPI:1881066314
Name:REIDER, LINDA SUSAN (CAC II, ATP)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:REIDER
Suffix:
Gender:F
Credentials:CAC II, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 A GAGE RD
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650
Mailing Address - Country:US
Mailing Address - Phone:970-989-3800
Mailing Address - Fax:
Practice Address - Street 1:1432 GRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3808
Practice Address - Country:US
Practice Address - Phone:970-945-7858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0007544101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)