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Individual

KELLY MARIE REAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.S.

Contact information

Practice address
5842 E NAPLES PLZ, LONG BEACH, CA 90803-5039
(562) 439-9539
(562) 439-2232
Mailing address
488 E OCEAN BLVD, #207, LONG BEACH, CA 90802-4761
(503) 970-6691
(562) 439-2232

Taxonomy

Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
AU2627
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2627
AUDIOLOGIST LICENSE
CA
Enumeration date
08/04/2008
Last updated
08/04/2008
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