Provider Demographics
NPI:1225049133
Name:REINHARDT, MARILYN J (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:J
Last Name:REINHARDT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MRS
Other - First Name:MARILYN
Other - Middle Name:J
Other - Last Name:LOSCHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:1941 S SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-3943
Mailing Address - Country:US
Mailing Address - Phone:217-544-1632
Mailing Address - Fax:217-544-4543
Practice Address - Street 1:1941 S SPRING ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-3943
Practice Address - Country:US
Practice Address - Phone:217-544-1632
Practice Address - Fax:217-544-4543
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR18414Medicare UPIN
ILK10874Medicare ID - Type Unspecified