Provider Demographics
NPI:1659341352
Name:REYNOLDS, JENNIFER MARIE (LMSW CSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LMSW CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 LUDINGTON ST
Mailing Address - Street 2:STE 401
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829
Mailing Address - Country:US
Mailing Address - Phone:906-789-1596
Mailing Address - Fax:906-789-2024
Practice Address - Street 1:1100 LUDINGTON ST
Practice Address - Street 2:STE 401
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829
Practice Address - Country:US
Practice Address - Phone:906-789-1596
Practice Address - Fax:906-789-2024
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010648981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP34440013Medicare PIN