Provider Demographics
NPI:1811401011
Name:JANICE REEDER APRN LLC
Entity Type:Organization
Organization Name:JANICE REEDER APRN LLC
Other - Org Name:JANICE REEDER LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:REEDER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:203-490-8862
Mailing Address - Street 1:14 STIRRUP LN
Mailing Address - Street 2:
Mailing Address - City:BARKHAMSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06063-3415
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 JEROME AVE STE 116
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2463
Practice Address - Country:US
Practice Address - Phone:860-836-5629
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5655251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health