Provider Demographics
NPI:1114449063
Name:RENNAKER, AMANDA BLAKE
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:BLAKE
Last Name:RENNAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E COLLEGE DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5570
Mailing Address - Country:US
Mailing Address - Phone:303-617-2300
Mailing Address - Fax:303-617-2365
Practice Address - Street 1:1309 E 3RD AVE UNIT B-5
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5255
Practice Address - Country:US
Practice Address - Phone:414-315-0897
Practice Address - Fax:303-617-2365
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical