Provider Demographics
NPI:1740536242
Name:REINECKE, ERICA S (ST)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:S
Last Name:REINECKE
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:S
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ST
Mailing Address - Street 1:2109 CEDARWOOD DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2670
Mailing Address - Country:US
Mailing Address - Phone:563-263-0557
Mailing Address - Fax:563-263-0560
Practice Address - Street 1:2109 CEDARWOOD DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2670
Practice Address - Country:US
Practice Address - Phone:563-263-0557
Practice Address - Fax:563-263-0560
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.002318235Z00000X
IA002258235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist