Provider Demographics
NPI:1154170363
Name:REESE, JOHNNY JR
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:REESE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 JERMAIN DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-4038
Mailing Address - Country:US
Mailing Address - Phone:419-304-8538
Mailing Address - Fax:419-725-9004
Practice Address - Street 1:316 N MICHIGAN
Practice Address - Street 2:SUITE 434
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604
Practice Address - Country:US
Practice Address - Phone:567-900-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-18
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator