Provider Demographics
NPI:1982624623
Name:TRIEGER, MICHAEL SCOTT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SCOTT
Last Name:TRIEGER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 LIBERTY DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6520
Mailing Address - Country:US
Mailing Address - Phone:217-793-3949
Mailing Address - Fax:217-793-3995
Practice Address - Street 1:3416 LIBERTY DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6520
Practice Address - Country:US
Practice Address - Phone:217-793-3949
Practice Address - Fax:217-793-3995
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071003515103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical