Provider Demographics
NPI:1346254893
Name:REINERS, KENNETH GEORGE (MA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:GEORGE
Last Name:REINERS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 ROSEMILL LN
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-2660
Mailing Address - Country:US
Mailing Address - Phone:763-323-2906
Mailing Address - Fax:763-576-1731
Practice Address - Street 1:11330 ROSEMILL LN
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-2660
Practice Address - Country:US
Practice Address - Phone:763-323-2906
Practice Address - Fax:763-576-1731
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN179101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral