Provider Demographics
NPI:1508878927
Name:RENWICK, JEFFREY SCOTT (MS, LICSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:RENWICK
Suffix:
Gender:M
Credentials:MS, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5877 267TH ST
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-9282
Mailing Address - Country:US
Mailing Address - Phone:612-672-1518
Mailing Address - Fax:651-464-4847
Practice Address - Street 1:5877 267TH ST
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-9282
Practice Address - Country:US
Practice Address - Phone:612-672-1518
Practice Address - Fax:651-464-4847
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62-23551OtherUBH
MN1016928OtherPREFERRED ONE
MN1749701OtherUNITED HEALTHCARE
MN232216100Medicaid
MN02G98REOtherBLUE CROSS BLUE SHIELD
MN20601OtherSIOUX VALLEY HEALTH
MN62-23551OtherMEDICA
MN116136OtherUCARE
MNHP37851OtherHEALTH PARTNERS