Provider Demographics
NPI:1891005419
Name:REYNOLDS, JAMES E II (MHS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:E
Last Name:REYNOLDS
Suffix:II
Gender:M
Credentials:MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5337 S WABASH AVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4601
Mailing Address - Country:US
Mailing Address - Phone:773-715-2678
Mailing Address - Fax:
Practice Address - Street 1:5337 S WABASH AVE
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4601
Practice Address - Country:US
Practice Address - Phone:773-715-2678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-16
Last Update Date:2010-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242001746235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist