Provider Demographics
NPI:1922751155
Name:REINEKE, TIFANIE M (LICSW)
Entity Type:Individual
Prefix:
First Name:TIFANIE
Middle Name:M
Last Name:REINEKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55975-1423
Mailing Address - Country:US
Mailing Address - Phone:701-214-9591
Mailing Address - Fax:
Practice Address - Street 1:908 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55975-1423
Practice Address - Country:US
Practice Address - Phone:701-214-9591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN215771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical