Provider Demographics
NPI:1386287076
Name:REISS, JONI (LAC)
Entity type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:REISS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7364 KINDLER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1249
Mailing Address - Country:US
Mailing Address - Phone:301-537-6241
Mailing Address - Fax:
Practice Address - Street 1:8344 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4653
Practice Address - Country:US
Practice Address - Phone:301-537-6241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist