Organization
NEUROBEHAVIORAL HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY M RENNIE PHD (OWNER)
(414) 803-0231
Entity
Organization
Contact information
Practice address
6110 N PORT WASHINGTON RD, GLENDALE, WI 53217-4308
(414) 803-0231
Mailing address
419 W RIVER FRONT DR, GLENDALE, WI 53217-4460
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
2478
WI
103T00000X
Psychologist
2478
WI
103TC2200X
Clinical Child & Adolescent Psychologist
2478
WI
Other
Enumeration date
09/11/2007
Last updated
09/11/2007
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