Provider Demographics
NPI:1912351792
Name:REAGAN GIELINCKI LLC
Entity Type:Organization
Organization Name:REAGAN GIELINCKI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REAGAN
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:GIELINCKI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR, IBCLC
Authorized Official - Phone:801-388-1640
Mailing Address - Street 1:410 N PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-9095
Mailing Address - Country:US
Mailing Address - Phone:801-388-1640
Mailing Address - Fax:
Practice Address - Street 1:410 N PATTERSON RD
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-9095
Practice Address - Country:US
Practice Address - Phone:801-388-1640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RNGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty