1447721634 NPI number — PATRICIA MARIE REINECKE LEBEDEVA LPCC

Table of content: PATRICIA MARIE REINECKE LEBEDEVA LPCC (NPI 1447721634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447721634 NPI number — PATRICIA MARIE REINECKE LEBEDEVA LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINECKE LEBEDEVA
Provider First Name:
PATRICIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447721634
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3104 CHELSEA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURNSVILLE
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55337-1000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-669-7377
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2021 E HENNEPIN AVE STE 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55413-1798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-435-7208
Provider Business Practice Location Address Fax Number:
612-435-7201
Provider Enumeration Date:
12/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  CC01566 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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