Basic Information
Provider Information
NPI: 1235384140
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REIBER
FirstName: OLIVIA
MiddleName: JEAN
NamePrefix: MS.
NameSuffix:  
Credential: LICSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9600 VETERANS DR SW
Address2: MS A122 SW BLDG 148
City: TACOMA
State: WA
PostalCode: 984930001
CountryCode: US
TelephoneNumber: 2535828440
FaxNumber: 2535894035
Practice Location
Address1: 9600 VETERANS DR SW
Address2: MS A122 SW BLDG 148
City: TACOMA
State: WA
PostalCode: 984930001
CountryCode: US
TelephoneNumber: 2535828440
FaxNumber: 2535894035
Other Information
ProviderEnumerationDate: 11/19/2008
LastUpdateDate: 01/22/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XLW 60286505WAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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