Provider Demographics
NPI:1912729443
Name:REITZ, KATHLEEN (MED)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:REITZ
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18025 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8300
Mailing Address - Country:US
Mailing Address - Phone:317-773-3171
Mailing Address - Fax:
Practice Address - Street 1:1350 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-3845
Practice Address - Country:US
Practice Address - Phone:317-773-0582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool