Provider Demographics
NPI:1588086839
Name:REISNER, MANDY (MA LMHC TEMPORARY)
Entity type:Individual
Prefix:MRS
First Name:MANDY
Middle Name:
Last Name:REISNER
Suffix:
Gender:F
Credentials:MA LMHC TEMPORARY
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:CLEWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:799 MAIN ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6825
Mailing Address - Country:US
Mailing Address - Phone:563-582-3784
Mailing Address - Fax:563-582-4006
Practice Address - Street 1:799 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6825
Practice Address - Country:US
Practice Address - Phone:563-582-3784
Practice Address - Fax:563-582-4006
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001523101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)