Healthcare Provider Details

I. General information

NPI: 1881522878
Provider Name (Legal Business Name): JACKIE REICHERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACKIE REICHERT

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 THOMAS RD S
BLOOMINGTON MN
55431-2471
US

IV. Provider business mailing address

9301 THOMAS RD S
BLOOMINGTON MN
55431-2471
US

V. Phone/Fax

Practice location:
  • Phone: 952-681-5338
  • Fax:
Mailing address:
  • Phone: 952-681-5338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number436614
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: