| Doctor Name: | TRACY RENDERMAN |
| NPI Number: | 1205212453 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | SAC, IDP |
| License Number: | 101YA0400X |
| Business Practice Address: | 2611 12th St S Wisconsin Rapids, WI - 544946445 |
| Business Phone Number: | 7154218869 |
| Business Fax Number: | |
| Mailing Address: | 2611 12th St S, WISCONSIN RAPIDS |
| State: | WI |
| Postal Code: | 544946445 |
| Phone Number: | 7156942188 |
| Fax Number: | |
| NPI Enumeration Date: | 08/10/2015 |
| NPI Last Update Date: | 08/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 101YA0400X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |