Healthcare Provider Details

I. General information

NPI: 1871002865
Provider Name (Legal Business Name): DENAY M REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5261 DELMAR BLVD STE 207
SAINT LOUIS MO
63108-1094
US

IV. Provider business mailing address

5261 DELMAR BLVD STE 207
SAINT LOUIS MO
63108-1094
US

V. Phone/Fax

Practice location:
  • Phone: 618-531-9003
  • Fax:
Mailing address:
  • Phone: 618-531-9003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: