Provider Demographics
NPI:1871878355
Name:REYNOLDS, NANCY LOUISE (LCSW,RN)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:LOUISE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2327 NW NORTHRUP ST APT 17
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2983
Mailing Address - Country:US
Mailing Address - Phone:503-719-6943
Mailing Address - Fax:503-227-2561
Practice Address - Street 1:319 SW WASHINGTON ST
Practice Address - Street 2:# 1015
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-2635
Practice Address - Country:US
Practice Address - Phone:503-735-5994
Practice Address - Fax:503-227-2561
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL45891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical