| Lisa Ridinger Pc | |
|
100 W Roosevelt Rd Ste B5-201 Wheaton IL 60187-5298 | |
| (630) 277-9465 | |
| Not Available |
| Full Name | Lisa Ridinger Pc |
|---|---|
| Speciality | Social Worker |
| Location | 100 W Roosevelt Rd Ste B5-201, Wheaton, Illinois |
| Authorized Official Name and Position | Lisa A Ridinger (PRESIDENT) |
| Authorized Official Contact | 6302779465 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Ridinger Pc 100 W Roosevelt Rd Ste B5-201 Wheaton IL 60187-5298 Ph: (630) 277-9465 | Lisa Ridinger Pc 100 W Roosevelt Rd Ste B5-201 Wheaton IL 60187-5298 Ph: (630) 277-9465 |
| NPI Number | 1487272639 |
|---|---|
| Provider Enumeration Date | 07/13/2020 |
| Last Update Date | 12/01/2020 |
| Certification Date | 12/01/2020 |
| Medicare PECOS PAC ID | 8527485523 |
|---|---|
| Medicare Enrollment ID | O20200903003080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487272639 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Lisa A Ridinger |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780725754 PECOS PAC ID: 3779816392 Enrollment ID: I20190612003014 |
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