Provider Demographics
NPI:1114676400
Name:REINKE, LOIS (MS,CCC)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:REINKE
Suffix:
Gender:F
Credentials:MS,CCC
Other - Prefix:
Other - First Name:SUZY
Other - Middle Name:
Other - Last Name:REINKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:150 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1710
Mailing Address - Country:US
Mailing Address - Phone:626-795-4213
Mailing Address - Fax:
Practice Address - Street 1:150 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1710
Practice Address - Country:US
Practice Address - Phone:626-795-4213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12020235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist