Provider Demographics
NPI:1902634066
Name:REIFSCHNEIDER, PHEBE ROSEANN (MS)
Entity type:Individual
Prefix:
First Name:PHEBE
Middle Name:ROSEANN
Last Name:REIFSCHNEIDER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:PHEBE
Other - Middle Name:ROSEANN
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:945 PACIFIC CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6973
Mailing Address - Country:US
Mailing Address - Phone:618-978-2171
Mailing Address - Fax:
Practice Address - Street 1:945 PACIFIC CROSSING DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-6973
Practice Address - Country:US
Practice Address - Phone:618-978-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019026086235Z00000X
IL146015696235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist