MEDICARE: REANIN STONE

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	106H00000X	Marriage & Family Therapist	208.000433	IL

General Provider Information

NPI Number	:	1124490925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REANIN STONE

Provider Business Mailing Address
First Line	:	8236 N 37TH ST
Second Line	:
City	:	BROWN DEER
State	:	WI
Zip	:	53209-1508
Country	:	US
Telephone Number	:	708-979-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	2266 N PROSPECT AVE STE 304
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-6306
Country	:	US
Telephone Number	:	414-405-0670
Fax Number	:

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

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	11/20/2024

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Directions to “ REANIN STONE ” Practice Location

Language	Start Address	Practice Location

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