Provider Demographics
NPI:1518796259
Name:KOLDENHOVEN, RILEY JO (LCSW)
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:JO
Last Name:KOLDENHOVEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3553 COUNTY ROAD 234
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-844-0523
Mailing Address - Fax:
Practice Address - Street 1:53 DUNN DR
Practice Address - Street 2:
Practice Address - City:FORT NOVOSEL
Practice Address - State:AL
Practice Address - Zip Code:36362-2105
Practice Address - Country:US
Practice Address - Phone:970-844-0523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5371C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical