Healthcare Provider Details

I. General information

NPI: 1013550581
Provider Name (Legal Business Name): KEBY REESE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 334
ROSEVILLE CA
95661-0334
US

IV. Provider business mailing address

PO BOX 334
ROSEVILLE CA
95661-0334
US

V. Phone/Fax

Practice location:
  • Phone: 916-546-3044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number136738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: