Healthcare Provider Details

I. General information

NPI: 1649185984
Provider Name (Legal Business Name): KAITLYN NICOLE RENWICK MA, NCC, CPC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 KIETZKE LN BLDG L
RENO NV
89502-5033
US

IV. Provider business mailing address

90 IRVING PARK CIR
RENO NV
89503-3502
US

V. Phone/Fax

Practice location:
  • Phone: 775-636-7767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCI5818
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: