Provider Demographics
NPI:1174519318
Name:REYNOLDS, JAN B (LCSW)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:B
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:10867 POLK ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-4700
Mailing Address - Country:US
Mailing Address - Phone:402-294-7886
Mailing Address - Fax:402-232-7291
Practice Address - Street 1:2501 CAPEHART RD
Practice Address - Street 2:EHRLING BERGQUIST HOSPITAL - FAMILY ADVOCACY CLINIC
Practice Address - City:OFFUTT A F B
Practice Address - State:NE
Practice Address - Zip Code:68113-1043
Practice Address - Country:US
Practice Address - Phone:402-294-7886
Practice Address - Fax:402-232-7291
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NELMHP - 1145/CMSW-6831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical