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General NPI Number Information
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NPI Number | 1881218824
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Entity Type | Individual
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Provider Name | KINZIE R REINS
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Gender | Male
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Dates
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Enumeration Date | 06/05/2020
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Last Update Date | 06/05/2020
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Provider Practice Location Address
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Address Line | 325 ILLINOIS RT 2
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City | DIXON
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State | IL
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Zip | 61021-9118
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Country | US
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Telephone | 815-284-6611
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Fax |
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Provider Business Mailing Address
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Address Line | 303 E 23RD ST APT 4
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City | STERLING
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State | IL
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Zip | 61081-1242
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Country | US
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Telephone | 815-718-4567
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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