Individual
TRACY RENDERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SAC, IDP
Contact information
Practice address
2611 12TH ST S, WISCONSIN RAPIDS, WI 54494-6445
(715) 421-8869
Mailing address
2611 12TH ST S, WISCONSIN RAPIDS, WI 54494-6445
(715) 694-2188
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YA0400X
—
Other
Enumeration date
08/10/2015
Last updated
08/10/2015
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