Provider Demographics
NPI:1730347451
Name:REINDERS, LORA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LORA
Middle Name:
Last Name:REINDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:
Other - Last Name:SCHULTZ REINDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4633 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-3552
Mailing Address - Country:US
Mailing Address - Phone:262-652-7222
Mailing Address - Fax:262-652-1734
Practice Address - Street 1:4633 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-4220
Practice Address - Country:US
Practice Address - Phone:262-652-7222
Practice Address - Fax:262-652-1734
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7448-123101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43738900Medicaid
WI43738900Medicaid