Individual
SAMUEL B RENNEBOHM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1401 MADISON ST STE 100, SEATTLE, WA 98104-1316
(206) 386-6111
(206) 386-6111
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY61016748
WA
Other
Enumeration date
07/25/2016
Last updated
09/30/2020
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