MEDICARE: DANIEL RENSTROM LMSW

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	1041C0700X	Clinical Social Worker	6801084943	MI

General Provider Information

NPI Number	:	1679645147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL RENSTROM LMSW

Provider Business Mailing Address
First Line	:	515 E STOCKBRIDGE AVE
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49001-2933
Country	:	US
Telephone Number	:	269-388-4875
Fax Number	:	269-276-5290

Provider Business Practice Location Address
First Line	:	16456 E C AVE
Second Line	:
City	:	AUGUSTA
State	:	MI
Zip	:	49012-9340
Country	:	US
Telephone Number	:	269-888-4212
Fax Number	:	269-276-5290

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	03/29/2024

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