MEDICARE: COLLEEN JO REINHARDT LISW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	01095	IA

General Provider Information

NPI Number	:	1063565083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN JO REINHARDT LISW

Provider Business Mailing Address
First Line	:	2327 70TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50322-4825
Country	:	US
Telephone Number	:	515-270-1344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2327 70TH ST
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50322-4825
Country	:	US
Telephone Number	:	515-270-1344
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	07/08/2007

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