Basic Information
| Provider Information | |||||||||
| NPI: | 1649794892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIEDSTRA | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.ED., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5330 CLEM RD | ||||||||
| Address2: | |||||||||
| City: | PORTAGE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463681474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8152071913 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1120 S CALUMET RD STE 3 | ||||||||
| Address2: | |||||||||
| City: | CHESTERTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463043286 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199839675 | ||||||||
| FaxNumber: | 2199839675 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2017 | ||||||||
| LastUpdateDate: | 02/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.