MEDICARE: JENNIFER SUE REINKE

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	106H00000X	Marriage & Family Therapist	2057	MN

General Provider Information

NPI Number	:	1366895401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER SUE REINKE

Provider Business Mailing Address
First Line	:	808 BERRY ST
Second Line	:	#109
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1064
Country	:	US
Telephone Number	:	713-226-9451
Fax Number	:

Provider Business Practice Location Address
First Line	:	2380 WYCLIFF ST
Second Line	:	#102
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1279
Country	:	US
Telephone Number	:	651-647-1083
Fax Number	:

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

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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Directions to “ JENNIFER SUE REINKE ” Practice Location

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