Active NPI
Maxine Lorraine Reynolds, MS, EDM CCC SP/A
- Speech-Language Pathologist
- Scotrun, PA
National Provider Identifier
1043464647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 4279
- Practice address
- 124 Scotrun Dr
Scotrun, PA 18355-9657 - Phone
- (570) 856-9599
- NPI assigned
- Nov 10, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 893-1 | NY | |
| Speech-Language Pathologist | 235Z00000X | 4279 | NY | Primary |
Addresses
Primary practice location
124 Scotrun Dr
Scotrun, PA 18355-9657
Mailing address
124 Scotrun Dr
Scotrun, PA 18355-9657
Phone (570) 856-9599
Other names 1
- Mrs. Maxine Lorraine Nevers
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 893-1 | NY | MD | Audiologist |
| 4279 | NY | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1226275200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226275200000",
"number": "1043464647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 SCOTRUN DR",
"city": "SCOTRUN",
"state": "PA",
"postal_code": "183559657",
"telephone_number": "570-856-9599"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 SCOTRUN DR",
"city": "SCOTRUN",
"state": "PA",
"postal_code": "183559657",
"telephone_number": "570-856-9599"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "MAXINE",
"middle_name": "LORRAINE",
"name_prefix": "Mrs.",
"credential": "MS, EDM CCC SP/A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-11-10",
"last_updated": "2008-11-10",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "NY",
"license": "893-1",
"primary": false
},
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NY",
"license": "4279",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MAXINE",
"last_name": "NEVERS",
"middle_name": "LORRAINE",
"prefix": "MRS.",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Scotrun, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.