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General NPI Number Information
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NPI Number | 1801458468
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Entity Type | Individual
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Provider Name | LORI ANN REINKE
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Gender | Female
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Dates
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Enumeration Date | 07/03/2019
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Last Update Date | 07/03/2019
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Provider Practice Location Address
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Address Line | 3280 W 3500 S STE E
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City | WEST VALLEY
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State | UT
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Zip | 84119-2668
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Country | US
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Telephone | 801-979-1351
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Fax |
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Provider Business Mailing Address
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Address Line | 2614 W 1300 S
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City | SYRACUSE
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State | UT
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Zip | 84075-8301
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Country | US
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Telephone | 480-215-8337
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 10694584-3904
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License Number State | UT
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