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General NPI Number Information
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NPI Number | 1992546899
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Entity Type | Individual
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Provider Name | REYNA MARIE RODRIGUEZ GILLENWATER
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Gender | Female
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 500 N MAIN ST
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City | NEWTON
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State | KS
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Zip | 67114-2200
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Country | US
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Telephone | 316-202-4414
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Fax |
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Provider Business Mailing Address
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Address Line | 211 W 9TH ST
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City | NEWTON
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State | KS
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Zip | 67114-1709
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Country | US
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Telephone | 210-275-3849
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 13632-T
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License Number State | KS
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