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General NPI Number Information
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NPI Number | 1083560627
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Entity Type | Individual
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Provider Name | MADELINE REESE MA
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Gender | Female
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Dates
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Enumeration Date | 03/06/2026
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Last Update Date | 03/06/2026
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Provider Practice Location Address
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Address Line | 412 PLYMOUTH AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-6028
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Country | US
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Telephone | 616-780-0590
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Fax |
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Provider Business Mailing Address
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Address Line | 412 PLYMOUTH AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49505-6028
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Country | US
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Telephone | 616-780-0590
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 6362010293
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License Number State | MI
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