Provider Demographics
NPI:1326013418
Name:REEB, ROGER N (PHD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:N
Last Name:REEB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 CUSHWA DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4316
Mailing Address - Country:US
Mailing Address - Phone:937-626-6300
Mailing Address - Fax:937-434-8590
Practice Address - Street 1:300 COLLEGE PARK AVE
Practice Address - Street 2:ST JOSHEPH HALL #306
Practice Address - City:UNIVERSITY OF DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45469-1430
Practice Address - Country:US
Practice Address - Phone:937-626-6300
Practice Address - Fax:937-434-8590
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5738103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2307855Medicaid
OH2307855Medicaid