MEDICARE: KATHRYN REIKER

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	2022016446	MO

General Provider Information

NPI Number	:	1528874708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN REIKER

Provider Business Mailing Address
First Line	:	11743 TWO MILE RD
Second Line	:
City	:	DEXTER
State	:	MO
Zip	:	63841-9152
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	521 STONECREST PKWY STE 102
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-6897
Country	:	US
Telephone Number	:	573-625-8151
Fax Number	:

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

Provider Enumeration Date	:	12/03/2024
Last Update Date	:	12/03/2024

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Directions to “ KATHRYN REIKER ” Practice Location

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