Individual
MIRANDA M RENNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SAC-IT
Contact information
Practice address
3301 N BALLARD RD STE B, APPLETON, WI 54911-9002
(920) 733-4443
Mailing address
3301 N BALLARD RD STE B, APPLETON, WI 54911-9002
(920) 733-4443
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20113-130
WI
Other
Enumeration date
01/05/2023
Last updated
01/05/2023
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