Provider Demographics
NPI:1992546899
Name:RODRIGUEZ GILLENWATER, REYNA MARIE
Entity type:Individual
Prefix:
First Name:REYNA
Middle Name:MARIE
Last Name:RODRIGUEZ GILLENWATER
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 1:211 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-1709
Mailing Address - Country:US
Mailing Address - Phone:210-275-3849
Mailing Address - Fax:
Practice Address - Street 1:500 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2200
Practice Address - Country:US
Practice Address - Phone:316-202-4414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13632-T104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker