Healthcare Provider Details

I. General information

NPI: 1063031979
Provider Name (Legal Business Name): REID HLAVKA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 07/15/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10TH MEDICAL GROUP 4102 PINION DRIVE
AIR FORCE ACADEMY CO
80840
US

IV. Provider business mailing address

10TH MEDICAL GROUP 4102 PINION DRIVE
AIR FORCE ACADEMY CO
80840
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-2273
  • Fax:
Mailing address:
  • Phone: 719-524-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007980
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: