Provider Demographics
NPI:1679098339
Name:REINHARDT, DANIEL (MS, SSP)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:REINHARDT
Suffix:
Gender:M
Credentials:MS, SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:IL
Mailing Address - Zip Code:62341-1500
Mailing Address - Country:US
Mailing Address - Phone:866-332-3880
Mailing Address - Fax:
Practice Address - Street 1:1830 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:IL
Practice Address - Zip Code:62341-1705
Practice Address - Country:US
Practice Address - Phone:866-332-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL675439103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool