Healthcare Provider Details

I. General information

NPI: 1902453236
Provider Name (Legal Business Name): VANESSA LYNN REYNHOUT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 01/11/2025
Certification Date: 01/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E PARIS AVE SE STE 160
GRAND RAPIDS MI
49546-8313
US

IV. Provider business mailing address

1500 S DOUGLAS RD STE 230
CORAL GABLES FL
33134-4108
US

V. Phone/Fax

Practice location:
  • Phone: 321-304-8301
  • Fax:
Mailing address:
  • Phone: 844-244-1818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: