Provider Demographics
NPI:1295009264
Name:WOELLERT, RENAE R (BS)
Entity Type:Individual
Prefix:MRS
First Name:RENAE
Middle Name:R
Last Name:WOELLERT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S ATKINSON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-7817
Mailing Address - Country:US
Mailing Address - Phone:847-548-9425
Mailing Address - Fax:847-984-5805
Practice Address - Street 1:100 S. ATKINSON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030
Practice Address - Country:US
Practice Address - Phone:847-548-9425
Practice Address - Fax:847-984-5805
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health