Provider Demographics
NPI:1689808750
Name:REINKE, LANCE DAVID (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:DAVID
Last Name:REINKE
Suffix:
Gender:M
Credentials:PSYD
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Mailing Address - Street 1:1749 S NAPERVILLE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5892
Mailing Address - Country:US
Mailing Address - Phone:630-260-8780
Mailing Address - Fax:630-938-4697
Practice Address - Street 1:2445 DEAN ST STE 1A
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-4828
Practice Address - Country:US
Practice Address - Phone:630-933-4662
Practice Address - Fax:630-938-4697
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL071007671103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical