Provider Demographics
NPI:1275882003
Name:RENZ, MARGARET MARY (MS)
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:MARY
Last Name:RENZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:MARGARET
Other - Middle Name:MARY
Other - Last Name:BAUMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12630 W NORTH AVE BLDG E
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4626
Mailing Address - Country:US
Mailing Address - Phone:262-785-1008
Mailing Address - Fax:262-432-9059
Practice Address - Street 1:12630 W NORTH AVE BLDG E
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-785-1008
Practice Address - Fax:262-432-9059
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1444-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1275882003Medicaid