Healthcare Provider Details

I. General information

NPI: 1730258898
Provider Name (Legal Business Name): RENEE A MCARDLE SR. PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4873 MANHATTAN DR
ROCKFORD IL
61108-2265
US

IV. Provider business mailing address

4873 MANHATTAN DR
ROCKFORD IL
61108-2265
US

V. Phone/Fax

Practice location:
  • Phone: 815-965-1817
  • Fax: 815-965-9574
Mailing address:
  • Phone: 815-965-1817
  • Fax: 815-965-9574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number071005330
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: