MEDICARE: ANN M. RENARD, PHD LP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	7012	MI

General Provider Information

NPI Number	:	1346386976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANN M. RENARD, PHD LP PC

Provider Business Mailing Address
First Line	:	2011 CROOKS RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-4049
Country	:	US
Telephone Number	:	248-414-4050
Fax Number	:	248-414-4053

Provider Business Practice Location Address
First Line	:	2011 CROOKS RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-4049
Country	:	US
Telephone Number	:	248-414-4050
Fax Number	:	248-414-4053

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST, OWNER
Name	:	DR. ANN MARIE RENARD
Credential	:	PHD, LP
Telephone Number	:	248-414-4050

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	02/19/2008

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