Provider Demographics
NPI:1417722703
Name:RENO, CALLIE ANN
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:ANN
Last Name:RENO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14409 ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:MI
Mailing Address - Zip Code:48442-8899
Mailing Address - Country:US
Mailing Address - Phone:248-660-7291
Mailing Address - Fax:
Practice Address - Street 1:14409 ROSEMARY DR
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:MI
Practice Address - Zip Code:48442-8899
Practice Address - Country:US
Practice Address - Phone:248-660-7291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician