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General NPI Number Information
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NPI Number | 1356123269
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Entity Type | Individual
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Provider Name | REYNA TOMANN LADC
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Gender | Female
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 3300 COUNTY ROAD 10 STE 100
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-3064
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Country | US
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Telephone | 651-447-8644
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Fax | 612-444-3292
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Provider Business Mailing Address
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Address Line | 3300 COUNTY ROAD 10
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City | BROOKLYN CENTER
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State | MN
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Zip | 55429-3072
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Country | US
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Telephone | 165-144-7864
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 306568
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License Number State | MN
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