Provider Demographics
NPI:1760723712
Name:RILEY, KIMBERLY JO (LMFT CSAC ICS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:RILEY
Suffix:
Gender:
Credentials:LMFT CSAC ICS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:J
Other - Last Name:HUTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT CSAC ICS
Mailing Address - Street 1:313 PRICE PL STE 208
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3262
Mailing Address - Country:US
Mailing Address - Phone:608-571-3866
Mailing Address - Fax:
Practice Address - Street 1:313 PRICE PL STE 208
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3262
Practice Address - Country:US
Practice Address - Phone:608-571-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15970-132101YA0400X
WI1014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)