Provider Demographics
NPI:1174972285
Name:REEDER WRIGHT, ANN
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:REEDER WRIGHT
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 1:1547 OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-1917
Mailing Address - Country:US
Mailing Address - Phone:765-641-7499
Mailing Address - Fax:765-356-4647
Practice Address - Street 1:1547 OHIO AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-1917
Practice Address - Country:US
Practice Address - Phone:765-641-7499
Practice Address - Fax:765-356-4647
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87000071A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN87000071AOtherSTATE LICENSE