Provider Demographics
NPI:1689321291
Name:REINKE, CODY LEE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:LEE
Last Name:REINKE
Suffix:
Gender:
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 JUDICIAL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-7822
Mailing Address - Country:US
Mailing Address - Phone:952-224-8990
Mailing Address - Fax:
Practice Address - Street 1:113 E HICKORY ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3630
Practice Address - Country:US
Practice Address - Phone:507-388-8114
Practice Address - Fax:507-388-8068
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30251104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker