Kylie Reynebeau

Primary specialty

Social WorkerTaxonomy code 104100000X

License

130190121 Issued in WI

Practice address

1499 6TH St
Green Bay, WI 54304-2252

Phone

(920) 497-6161

Fax

(920) 498-0476

NPI assigned

Jun 20, 2016

Last updated

Jun 20, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Innovative Counseling Inc

  • Community/Behavioral Health Agency
  • Green Bay, WI
  • NPI 1093869588
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466380800000",
    "number": "1275983348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1499 6TH ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042252",
            "telephone_number": "920-497-6161",
            "fax_number": "920-498-0476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1499 6TH ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543042252",
            "telephone_number": "920-497-6161",
            "fax_number": "920-498-0476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNEBEAU",
        "first_name": "KYLIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-20",
        "last_updated": "2016-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "130190121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jason Douglas Retzke, M.D.
• Kelly Lauretta Retzlaff, AUD
• Courtney Rose Revoir
• William Joseph Reynders, M.D.
• William M Reynders, MD
• Kathleen F. Reynolds, RN
• Pamela Norma Reynolds, CRNA
• Lynn D. Rezachek, RN
• Shelly Reznichek, PT
• Brennan Elizabeth Rhea, CAA

• Social Worker in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Social Worker in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.