MEDICARE: TODD REID

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	1041C0700X	Clinical Social Worker	6801088768	MI
2	104100000X	Social Worker	6801088768	MI

General Provider Information

NPI Number	:	1366570582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TODD REID

Provider Business Mailing Address
First Line	:	13720 VERNON ST
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1387
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13720 VERNON ST
Second Line	:
City	:	OAK PARK
State	:	MI
Zip	:	48237-1387
Country	:	US
Telephone Number	:	313-818-1703
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	06/29/2023

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Directions to “ TODD REID ” Practice Location

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