MEDICARE: SANDRA GAIL RENNER MA

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	101Y00000X	Counselor	LH00005486	WA

General Provider Information

NPI Number	:	1952441388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA GAIL RENNER MA

Provider Business Mailing Address
First Line	:	4125 43RD AVE S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-1204
Country	:	US
Telephone Number	:	206-484-4142
Fax Number	:

Provider Business Practice Location Address
First Line	:	5100 S DAWSON ST STE 204
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98118-2100
Country	:	US
Telephone Number	:	206-484-4142
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	12/04/2020

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