MEDICARE: MS. SENITA REYNOLDS LLMSW

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	6851103179	MI

General Provider Information

NPI Number	:	1649043043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SENITA REYNOLDS LLMSW

Provider Business Mailing Address
First Line	:	1536 GULL RD
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1621
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1536 GULL RD
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49048-1621
Country	:	US
Telephone Number	:	269-251-4659
Fax Number	:

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

Provider Enumeration Date	:	11/07/2023
Last Update Date	:	11/07/2023

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