Healthcare Provider Details

I. General information

NPI: 1144221490
Provider Name (Legal Business Name): TRINA REITER USW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E AVE NW SUITE 101
CEDAR RAPIDS IA
52405-2962
US

IV. Provider business mailing address

800 1ST ST NW
CEDAR RAPIDS IA
52405-2713
US

V. Phone/Fax

Practice location:
  • Phone: 319-396-3110
  • Fax: 319-396-8779
Mailing address:
  • Phone: 319-396-1066
  • Fax: 319-378-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05721
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier44940
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBCBS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: