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General NPI Number Information
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NPI Number | 1063802619
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Entity Type | Individual
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Provider Name | RENEE WERNER LPC
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Gender | Female
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 5732 E RIVERSIDE BLVD
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City | LOVES PARK
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State | IL
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Zip | 61111-4938
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Country | US
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Telephone | 815-978-8013
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Fax |
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Provider Business Mailing Address
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Address Line | 830 TAMPA DR
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City | MACHESNEY PARK
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State | IL
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Zip | 61115-1649
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Country | US
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Telephone | 815-978-8013
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.010694
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License Number State | IL
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