Provider Demographics
NPI:1104898477
Name:REINKE, HOLLY A (AUD)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:A
Last Name:REINKE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 N COLUMBUS ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8408
Mailing Address - Country:US
Mailing Address - Phone:740-654-3300
Mailing Address - Fax:740-654-3343
Practice Address - Street 1:2670 N COLUMBUS ST
Practice Address - Street 2:SUITE B
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8408
Practice Address - Country:US
Practice Address - Phone:740-654-3300
Practice Address - Fax:740-654-3343
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA01115231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000035900OtherANTHEM
OH000000503368OtherANTHEM
OH2068631Medicaid
OH000000035900OtherANTHEM