Provider Demographics
NPI:1235214446
Name:REIBER, JUDY
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:
Last Name:REIBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 BROADWAY ST NE STE 160
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1756
Mailing Address - Country:US
Mailing Address - Phone:612-378-2363
Mailing Address - Fax:612-378-2215
Practice Address - Street 1:3433 BROADWAY ST NE STE 160
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1756
Practice Address - Country:US
Practice Address - Phone:612-378-2363
Practice Address - Fax:612-378-2215
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8G864REOtherBLUE CROSS
MN56653PROtherPRIMARY HEALTH BLUE CROSS