Provider Demographics
NPI:1114316759
Name:RENNINGER, SALINA (LP)
Entity Type:Individual
Prefix:
First Name:SALINA
Middle Name:
Last Name:RENNINGER
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 CLEVELAND AVE N
Mailing Address - Street 2:#200
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-5031
Mailing Address - Country:US
Mailing Address - Phone:651-401-5568
Mailing Address - Fax:
Practice Address - Street 1:475 CLEVELAND AVE N
Practice Address - Street 2:#200
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-5031
Practice Address - Country:US
Practice Address - Phone:651-401-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4003103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling