Healthcare Provider Details

I. General information

NPI: 1215615547
Provider Name (Legal Business Name): JONI REBECCA REYNA CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JONI REBECCA WALLENT

II. Dates (important events)

Enumeration Date: 07/07/2023
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

REGIONAL HEALTH COMMAND EUROPE, UNIT 29421
APO AE
09136
DE

IV. Provider business mailing address

REGIONAL HEALTH COMMAND, UNIT 294921
APO DE
09136
DE

V. Phone/Fax

Practice location:
  • Phone: 314-590-1121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09929370
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: