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General NPI Number Information
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NPI Number | 1558571216
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Entity Type | Individual
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Provider Name | FREDERICK A. REYNOLDS MSW
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Gender | Male
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | VA MEDICAL CENTER 5500 ARMSTRONG RD.
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City | BATTLE CREEK
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State | MI
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Zip | 49015
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Country | US
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Telephone | 269-966-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 3222 N 38TH ST
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City | AUGUSTA
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State | MI
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Zip | 49012-9247
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Country | US
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Telephone | 269-501-2761
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801087630
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License Number State | MI
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