MEDICARE: MUNI REDDY

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	:	1144604265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MUNI REDDY

Provider Business Mailing Address
First Line	:	5455 MCLEOD LN NE APT 104
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-2329
Country	:	US
Telephone Number	:	503-501-6991
Fax Number	:

Provider Business Practice Location Address
First Line	:	5455 MCLEOD LN NE APT 104
Second Line	:
City	:	KEIZER
State	:	OR
Zip	:	97303-2329
Country	:	US
Telephone Number	:	503-501-6991
Fax Number	:

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

Provider Enumeration Date	:	07/18/2015
Last Update Date	:	01/21/2019

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Directions to “ MUNI REDDY ” Practice Location

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