Provider Demographics
NPI:1972883163
Name:REISINGER, JONI LYNN (PMHP)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:LYNN
Last Name:REISINGER
Suffix:
Gender:F
Credentials:PMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5858
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5858
Mailing Address - Country:US
Mailing Address - Phone:308-381-7487
Mailing Address - Fax:308-381-2712
Practice Address - Street 1:4111 4TH AVE
Practice Address - Street 2:STE 18
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2884
Practice Address - Country:US
Practice Address - Phone:308-381-7487
Practice Address - Fax:308-381-2712
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098184OtherMEDICARE
NE47077707526Medicaid