Provider Demographics
NPI:1801422456
Name:REIKOFSKI, HEATHER
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:REIKOFSKI
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 1:122 POWELLS
Mailing Address - Street 2:
Mailing Address - City:CRESCENT
Mailing Address - State:IA
Mailing Address - Zip Code:51526-3014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 N 16TH ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-0105
Practice Address - Country:US
Practice Address - Phone:712-256-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079753101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor