Healthcare Provider Details

I. General information

NPI: 1740095256
Provider Name (Legal Business Name): ANDREW REUM II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 LAKE AVE
FORT WAYNE IN
46805-5359
US

IV. Provider business mailing address

2270 LAKE AVE
FORT WAYNE IN
46805-5359
US

V. Phone/Fax

Practice location:
  • Phone: 260-444-5649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-16896
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: