Provider Demographics
NPI:1154835627
Name:RIENDEAU, WAYNE KENNETH (LPC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:KENNETH
Last Name:RIENDEAU
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CORTLAND CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-2334
Mailing Address - Country:US
Mailing Address - Phone:847-744-0111
Mailing Address - Fax:
Practice Address - Street 1:3 CORTLAND CIR
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-2334
Practice Address - Country:US
Practice Address - Phone:847-744-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011980101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health