Provider Demographics
NPI:1518450840
Name:REIKOWSKY, DESTINY E (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:DESTINY
Middle Name:E
Last Name:REIKOWSKY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:E
Other - Last Name:HELPAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:11308 AUTUMN BREEZE TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-1592
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11308 AUTUMN BREEZE TRL STE 1
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:MI
Practice Address - Zip Code:48420-1592
Practice Address - Country:US
Practice Address - Phone:989-996-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801116694104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI15140840Medicaid