Healthcare Provider Details

I. General information

NPI: 1073519575
Provider Name (Legal Business Name): JEFFREY P REILAND CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 SOUTH AVE
LA CROSSE WI
54601-5467
US

IV. Provider business mailing address

1900 SOUTH AVE
LA CROSSE WI
54601-5467
US

V. Phone/Fax

Practice location:
  • Phone: 608-775-2287
  • Fax:
Mailing address:
  • Phone: 608-775-2287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1391
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: