=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457204018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENEW PSYCHOLOGICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/16/2026
-----------------------------------------------------
Last Update Date | 02/16/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3450 LEXINGTON AVE N STE 211
-----------------------------------------------------
City | SHOREVIEW
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55126-8163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-387-5082
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30000 GLADER BLVD
-----------------------------------------------------
City | LINDSTROM
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55045-9028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-387-5082
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | DR. ERIKA WIGHT
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 612-387-5082
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------