Provider Demographics
NPI:1366992448
Name:REICHEL, SAUNDRA
Entity type:Individual
Prefix:
First Name:SAUNDRA
Middle Name:
Last Name:REICHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 WADE AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-9435
Mailing Address - Country:US
Mailing Address - Phone:440-992-1270
Mailing Address - Fax:440-992-1272
Practice Address - Street 1:2308 WADE AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-9435
Practice Address - Country:US
Practice Address - Phone:440-992-1270
Practice Address - Fax:440-992-1272
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20887621103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool