Doctor Name: | RENEE WERNER |
NPI Number: | 1063802619 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 178.010694 |
Business Practice Address: | 5732 E Riverside Blvd Loves Park, IL - 611114938 |
Business Phone Number: | 8159788013 |
Business Fax Number: | |
Mailing Address: | 830 Tampa Dr, MACHESNEY PARK |
State: | IL |
Postal Code: | 611151649 |
Phone Number: | 8159788013 |
Fax Number: | |
NPI Enumeration Date: | 02/03/2015 |
NPI Last Update Date: | 02/03/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 178.010694 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |