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General NPI Number Information
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NPI Number | 1962604348
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Entity Type | Individual
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Provider Name | KRISTINA MARIE RENAUD B.S., R.S.S.T
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Gender | Female
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Dates
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Enumeration Date | 06/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 26184 OUTER DR
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City | LINCOLN PARK
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State | MI
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Zip | 48146-2084
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Country | US
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Telephone | 313-389-7598
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Fax | 313-389-7515
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Provider Business Mailing Address
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Address Line | 1259 WILSON AVE
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City | LINCOLN PARK
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State | MI
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Zip | 48146-2036
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Country | US
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Telephone | 313-389-7598
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Fax | 313-389-7515
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6803074970
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License Number State | MI
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