Provider Demographics
NPI:1285845123
Name:REINKE, MELODIE JEANNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MELODIE
Middle Name:JEANNIE
Last Name:REINKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 N SUMMERWIND PL
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-3463
Mailing Address - Country:US
Mailing Address - Phone:208-922-9001
Mailing Address - Fax:208-922-3778
Practice Address - Street 1:190 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634
Practice Address - Country:US
Practice Address - Phone:208-922-9001
Practice Address - Fax:208-922-3778
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-11831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical