Provider Demographics
NPI:1275035040
Name:REITZ, NICOLE LYNN (MA, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:LYNN
Last Name:REITZ
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-5034
Mailing Address - Country:US
Mailing Address - Phone:605-394-1851
Mailing Address - Fax:605-394-5391
Practice Address - Street 1:1701 DOWNING ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-0701
Practice Address - Country:US
Practice Address - Phone:605-394-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD323235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist