Individual
DOMINIQUE KRISTINE RENYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BA
Contact information
Practice address
1027 E BURNSIDE ST, PORTLAND, OR 97214
(503) 239-8400
(503) 239-8407
Mailing address
1027 E BURNSIDE ST, PORTLAND, OR 97216
(503) 239-8400
(503) 239-8407
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123190
—
OR
Enumeration date
09/20/2010
Last updated
06/05/2018
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