Provider Demographics
NPI:1598181059
Name:REISS, ANA LAUREN (MS)
Entity Type:Individual
Prefix:MS
First Name:ANA LAUREN
Middle Name:
Last Name:REISS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANA LAUREN
Other - Middle Name:REISS
Other - Last Name:BOYLSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:501 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-2909
Mailing Address - Country:US
Mailing Address - Phone:503-538-4874
Mailing Address - Fax:
Practice Address - Street 1:501 E 1ST ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2909
Practice Address - Country:US
Practice Address - Phone:503-538-4874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor