Individual
JENNIFER REAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
201 IL ROUTE 64, LANARK, IL 61046-8903
(815) 493-2321
Mailing address
201 IL ROUTE 64, LANARK, IL 61046-8903
(815) 493-2321
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36-2663577
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3000006
DHS DDD MCO PLAN
IL
01
—
7094638
DHS DDD BILLING AGENT
IL
Enumeration date
08/02/2016
Last updated
08/02/2016
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