Provider Demographics
NPI:1821615915
Name:REITZ, JENNIFER RYAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RYAN
Last Name:REITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 WELDON PKWY
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3115
Mailing Address - Country:US
Mailing Address - Phone:314-569-2253
Mailing Address - Fax:
Practice Address - Street 1:140 WELDON PKWY
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3115
Practice Address - Country:US
Practice Address - Phone:314-569-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170050021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical