Provider Demographics
NPI:1346213527
Name:BENTLEY, RENEE A W
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:A W
Last Name:BENTLEY
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:PO BOX 1767
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-1767
Mailing Address - Country:US
Mailing Address - Phone:616-527-2619
Mailing Address - Fax:616-527-7717
Practice Address - Street 1:453 DILDINE RD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-9564
Practice Address - Country:US
Practice Address - Phone:616-527-2619
Practice Address - Fax:616-527-7717
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010334621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical