Provider Demographics
NPI:1326443888
Name:REICHERT, MARIE COLLEEN (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:COLLEEN
Last Name:REICHERT
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:COLLEEN
Other - Last Name:STACK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2560 METRO BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2417
Mailing Address - Country:US
Mailing Address - Phone:314-715-3855
Mailing Address - Fax:314-447-6520
Practice Address - Street 1:2560 METRO BLVD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2417
Practice Address - Country:US
Practice Address - Phone:314-715-3855
Practice Address - Fax:314-447-6520
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014035971103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst