Provider Demographics
NPI:1467826990
Name:BIRKHOLZ, RENEE (LPC-IT, SAS)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:BIRKHOLZ
Suffix:
Gender:F
Credentials:LPC-IT, SAS
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:VANDEN HEUVEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:VANDEN HEUVEL
Mailing Address - Street 1:1002 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1808
Mailing Address - Country:US
Mailing Address - Phone:608-356-9055
Mailing Address - Fax:608-356-5447
Practice Address - Street 1:2901 HUNTERS TRL
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-3403
Practice Address - Country:US
Practice Address - Phone:608-742-5518
Practice Address - Fax:608-742-4087
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2645-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1467826990Medicaid