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General NPI Number Information
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NPI Number | 1972353910
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Entity Type | Organization
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Legal Business Name | RENEWAL THERAPY PLLC
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 2650 W MONTROSE AVE STE 200
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City | CHICAGO
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State | IL
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Zip | 60618-1674
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Country | US
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Telephone | 312-600-5582
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Fax |
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Provider Business Mailing Address
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Address Line | 1247 N BOSWORTH AVE APT 2S
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City | CHICAGO
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State | IL
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Zip | 60642-3446
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Country | US
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Telephone | 219-776-5257
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | ELIZABETH BUDDE
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Credential | LCSW
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Telephone | 312-600-5582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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