Provider Demographics
NPI:1174636211
Name:REIFENSTUHL, JOHN C (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:REIFENSTUHL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5970
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-5312
Mailing Address - Country:US
Mailing Address - Phone:630-424-9482
Mailing Address - Fax:
Practice Address - Street 1:800 W FIFTH AVE
Practice Address - Street 2:STE 101A
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563
Practice Address - Country:US
Practice Address - Phone:630-778-6159
Practice Address - Fax:360-357-3093
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490072911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical