Healthcare Provider Details

I. General information

NPI: 1871457044
Provider Name (Legal Business Name): LATASHA JOLEE REISINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 FOURTH ST
CHARLOTTE MI
48813-2181
US

IV. Provider business mailing address

541 FOURTH ST
CHARLOTTE MI
48813-2181
US

V. Phone/Fax

Practice location:
  • Phone: 517-204-4470
  • Fax: 517-204-4470
Mailing address:
  • Phone: 517-204-4470
  • Fax: 517-204-4470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121145
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: