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General NPI Number Information
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NPI Number | 1891004149
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Entity Type | Organization
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Legal Business Name | REINKE PSYCHOLOGICAL SERVICES PC
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 10/05/2010
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Provider Practice Location Address
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Address Line | 806 W BARTLETT RD SUITE 202
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City | BARTLETT
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State | IL
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Zip | 60103-4400
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Country | US
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Telephone | 630-709-9449
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8211
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City | BARTLETT
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State | IL
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Zip | 60103-8211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CLINICAL PSYCHOLOGIST
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Name | REBECCA REINKE
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Credential | PSY.D.
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Telephone | 630-709-9449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006857
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License Number State | IL
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