MEDICARE: SUSAN M. REED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1033309984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN M. REED

Provider Business Mailing Address
First Line	:	1963 N E ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-3919
Country	:	US
Telephone Number	:	909-881-6146
Fax Number	:	909-881-0111

Provider Business Practice Location Address
First Line	:	1963 N E ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-3919
Country	:	US
Telephone Number	:	909-881-6146
Fax Number	:	909-881-0111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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