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General NPI Number Information
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NPI Number | 1093339079
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Entity Type | Individual
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Provider Name | MICHELLE RENEA BERENDSEN
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Gender | Female
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 7 WAVELAND AVE
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City | WINCHESTER
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State | KY
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Zip | 40391-1231
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Country | US
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Telephone | 859-385-4669
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Fax | 614-227-9447
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Provider Business Mailing Address
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Address Line | 1801 WATERMARK DR STE 200
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City | COLUMBUS
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State | OH
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Zip | 43215-7088
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Country | US
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Telephone | 614-487-8758
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Fax | 614-227-9447
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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