Healthcare Provider Details

I. General information

NPI: 1366845216
Provider Name (Legal Business Name): REBEKAH ANNE REYNOLDS L.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKAH ANNE BRUENING

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12557 RAVENWOOD DR
CHARDON OH
44024-9009
US

IV. Provider business mailing address

14568 LINDA DR
NEWBURY OH
44065-9749
US

V. Phone/Fax

Practice location:
  • Phone: 440-285-3568
  • Fax: 440-285-4552
Mailing address:
  • Phone: 440-708-8543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1200217
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: