Provider Demographics
NPI:1629396346
Name:REICKS, KATHRYN A (SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:REICKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1569
Mailing Address - Country:US
Mailing Address - Phone:616-846-8196
Mailing Address - Fax:616-842-0886
Practice Address - Street 1:12265 JAMES ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8613
Practice Address - Country:US
Practice Address - Phone:616-393-5641
Practice Address - Fax:616-393-5687
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004004235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist