Healthcare Provider Details

I. General information

NPI: 1508491069
Provider Name (Legal Business Name): REINHARDT RYDEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2020
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5197 NW LOWER RIVER RD BLDG 1
VANCOUVER WA
98660-1013
US

IV. Provider business mailing address

9916 NE HIGHWAY 99
VANCOUVER WA
98686-5608
US

V. Phone/Fax

Practice location:
  • Phone: 360-605-6001
  • Fax:
Mailing address:
  • Phone: 971-275-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1508491069
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: