Provider Demographics
NPI:1104911809
Name:REINARTZ, KELLY STELLA (SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:STELLA
Last Name:REINARTZ
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5133 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134
Mailing Address - Country:US
Mailing Address - Phone:440-503-2707
Mailing Address - Fax:
Practice Address - Street 1:5311 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-3800
Practice Address - Country:US
Practice Address - Phone:440-842-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.7821235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0842995Medicaid
OH000000217475OtherANTHEMBLUECROSSBLUESHIELD
OH000000217475OtherANTHEMBLUECROSSBLUESHIELD