Provider Demographics
NPI:1275823643
Name:MOST, RENEE J (MA LADC)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:J
Last Name:MOST
Suffix:
Gender:F
Credentials:MA LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1453 ELDRIDGE AVE E
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-3519
Mailing Address - Country:US
Mailing Address - Phone:651-283-1182
Mailing Address - Fax:
Practice Address - Street 1:1453 ELDRIDGE AVE E
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-3519
Practice Address - Country:US
Practice Address - Phone:651-283-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302137101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)