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NPI Code Detail

MEDICARE: DR. LANCE DAVID REINKE PSY.D.

MEDICARE: DR. LANCE DAVID REINKE PSY.D.
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
1103TC0700XClinical Psychologist071007671IL
2103G00000XClinical Neuropsychologist071007671IL

General Provider Information

NPI Number : 1689808750
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LANCE DAVID REINKE PSY.D.
Provider Business Mailing Address
First Line : 1749 S NAPERVILLE RD STE 106
Second Line :
City : WHEATON
State : IL
Zip : 60189-5892
Country : US
Telephone Number : 630-260-8780
Fax Number : 630-938-4697
Provider Business Practice Location Address
First Line : 2445 DEAN ST STE 1A
Second Line :
City : ST CHARLES
State : IL
Zip : 60175-4828
Country : US
Telephone Number : 630-933-4662
Fax Number : 630-938-4697
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2009
Last Update Date : 12/15/2022

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