Provider Demographics
NPI:1073577789
Name:REIJONEN, JORI H (PHD)
Entity Type:Individual
Prefix:
First Name:JORI
Middle Name:H
Last Name:REIJONEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 N 10TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-5733
Mailing Address - Country:US
Mailing Address - Phone:269-375-4363
Mailing Address - Fax:269-375-4362
Practice Address - Street 1:1090 N 10TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5733
Practice Address - Country:US
Practice Address - Phone:269-375-4363
Practice Address - Fax:269-375-4362
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301009200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0C97625105Medicare PIN
Q467861Medicare UPIN