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NPI Code Detail

MEDICARE: GRETCHEN RENFRO MSW, LCSW

MEDICARE: GRETCHEN RENFRO MSW, LCSW
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
11041C0700XClinical Social Worker149006216IL

General Provider Information

NPI Number : 1265072615
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRETCHEN RENFRO MSW, LCSW
Provider Business Mailing Address
First Line : 1637 TULANE DR
Second Line :
City : NAPERVILLE
State : IL
Zip : 60565-1736
Country : US
Telephone Number : 630-222-3639
Fax Number :
Provider Business Practice Location Address
First Line : 1500 EISENHOWER LN STE 900
Second Line :
City : LISLE
State : IL
Zip : 60532-2135
Country : US
Telephone Number : 630-428-7890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2020
Last Update Date : 11/27/2023

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