Individual
MRS. RENE ANN BURGOYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, ATRL-BC
Contact information
Practice address
12970 W BLUEMOUND RD, SUITE 308, ELM GROVE, WI 53122-2607
(262) 780-1020
(262) 780-1022
Mailing address
12970 W BLUEMOUND RD, SUITE 308, ELM GROVE, WI 53122-2607
(262) 780-1020
(262) 780-1022
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3853-125
WI
221700000X
Art Therapist
66-036
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40967900
—
WI
01
—
66-036
ART THERAPIST
WI
Enumeration date
09/29/2006
Last updated
09/18/2008
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