Individual
RENEE M KERANEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
121 W MAIN ST, PORT WASHINGTON, WI 53074-1813
(262) 284-8133
(262) 284-8104
Mailing address
121 W MAIN ST, PORT WASHINGTON, WI 53074-1813
(262) 284-8133
(262) 284-8104
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7713-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7713-123
LICENSE
WI
01
—
K400202255
MEDICARE PTAN
—
Enumeration date
10/10/2014
Last updated
04/03/2015
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