Provider Demographics
NPI:1154400703
Name:REITZLER, KELLY SUE (LMHC, CADC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SUE
Last Name:REITZLER
Suffix:
Gender:F
Credentials:LMHC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 ROCKFORD RD SW
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-1870
Mailing Address - Country:US
Mailing Address - Phone:319-430-5992
Mailing Address - Fax:
Practice Address - Street 1:1073 ROCKFORD RD SW
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-1870
Practice Address - Country:US
Practice Address - Phone:319-530-5992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01016101YA0400X
IA00840101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)