Provider Demographics
NPI:1467469791
Name:RENNERT, CATHERINE LUCAS (LCPC)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:LUCAS
Last Name:RENNERT
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HARLEM BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61103-6339
Mailing Address - Country:US
Mailing Address - Phone:815-968-1157
Mailing Address - Fax:
Practice Address - Street 1:1615 HARLEM BLVD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61103-6339
Practice Address - Country:US
Practice Address - Phone:815-968-1157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health