Healthcare Provider Details

I. General information

NPI: 1730726076
Provider Name (Legal Business Name): RENAE NICOLE ROMSTADT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2019
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1832 ADAMS ST
TOLEDO OH
43604-4428
US

IV. Provider business mailing address

1832 ADAMS ST
TOLEDO OH
43604-4428
US

V. Phone/Fax

Practice location:
  • Phone: 419-720-9247
  • Fax:
Mailing address:
  • Phone: 419-720-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2406365
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: