MEDICARE: RENEE WERNER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	178.010694	IL

General Provider Information

NPI Number	:	1063802619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE WERNER LPC

Provider Business Mailing Address
First Line	:	830 TAMPA DR
Second Line	:
City	:	MACHESNEY PARK
State	:	IL
Zip	:	61115-1649
Country	:	US
Telephone Number	:	815-978-8013
Fax Number	:

Provider Business Practice Location Address
First Line	:	5732 E RIVERSIDE BLVD
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-4938
Country	:	US
Telephone Number	:	815-978-8013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2015
Last Update Date	:	02/03/2015

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