Healthcare Provider Details

I. General information

NPI: 1952780686
Provider Name (Legal Business Name): REINEKE CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 RAYBROOK ST SE STE 308
GRAND RAPIDS MI
49546-7717
US

IV. Provider business mailing address

2020 RAYBROOK ST SE STE 308
GRAND RAPIDS MI
49546-7717
US

V. Phone/Fax

Practice location:
  • Phone: 616-649-1010
  • Fax: 616-551-2895
Mailing address:
  • Phone: 616-649-1010
  • Fax: 616-551-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301009314
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301009314
License Number StateMI

VIII. Authorized Official

Name: DR. LORI REINEKE
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 616-649-1010