Provider Demographics
NPI:1467473447
Name:REETZ, MARLYS JOANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARLYS
Middle Name:JOANN
Last Name:REETZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARLYS
Other - Middle Name:REETZ
Other - Last Name:ELDRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:970 W WOOSTER ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2643
Mailing Address - Country:US
Mailing Address - Phone:419-352-6666
Mailing Address - Fax:419-353-1117
Practice Address - Street 1:970 W WOOSTER ST
Practice Address - Street 2:SUITE 124
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2643
Practice Address - Country:US
Practice Address - Phone:419-352-6666
Practice Address - Fax:419-353-1117
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3434103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRECP10592Medicare ID - Type Unspecified