Provider Demographics
NPI:1689321291
Name:REINKE, CODY LEE (MSW, LGSW)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:LEE
Last Name:REINKE
Suffix:
Gender:M
Credentials:MSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3630
Mailing Address - Country:US
Mailing Address - Phone:507-386-3903
Mailing Address - Fax:507-388-8068
Practice Address - Street 1:113 E HICKORY ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3630
Practice Address - Country:US
Practice Address - Phone:507-388-8114
Practice Address - Fax:507-388-8068
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30251104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker