Healthcare Provider Details

I. General information

NPI: 1316551468
Provider Name (Legal Business Name): JENNIFER LYNN REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2020
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7322 MARINGO DR
HUBER HEIGHTS OH
45424-3151
US

IV. Provider business mailing address

7322 MARINGO DR
HUBER HEIGHTS OH
45424-3151
US

V. Phone/Fax

Practice location:
  • Phone: 937-409-2193
  • Fax:
Mailing address:
  • Phone: 937-409-2193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number587327303
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: