Healthcare Provider Details

I. General information

NPI: 1548180052
Provider Name (Legal Business Name): MICHELLE ALICIA RENNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE SCHILLING

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SARGENT DR
FREDERICKTOWN MO
63645-7526
US

IV. Provider business mailing address

1115 MADISON 9230
FREDERICKTOWN MO
63645-7830
US

V. Phone/Fax

Practice location:
  • Phone: 573-783-4400
  • Fax:
Mailing address:
  • Phone: 573-783-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026023972
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: