Healthcare Provider Details

I. General information

NPI: 1952893752
Provider Name (Legal Business Name): LOURDES REYES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 11/02/2024
Certification Date: 11/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 N UNION BLVD STE 202
COLORADO SPRINGS CO
80918-2069
US

IV. Provider business mailing address

800 S ELDORADO ROAD STE 300
BLOOMINGTON IL
61704
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax: 888-965-4615
Mailing address:
  • Phone: 331-529-6833
  • Fax: 315-296-8333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149027248
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09930791
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150104570
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: