Provider Demographics
NPI:1750705083
Name:REKERS, PAUL (LISW)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:REKERS
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 BURKHARDT RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2932
Mailing Address - Country:US
Mailing Address - Phone:937-259-6625
Mailing Address - Fax:937-259-6648
Practice Address - Street 1:5800 BURKHARDT RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:OH
Practice Address - Zip Code:45431-2932
Practice Address - Country:US
Practice Address - Phone:937-259-6625
Practice Address - Fax:937-259-6648
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00072291041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool