Provider Demographics
NPI:1508904368
Name:RITTER, RENAE SUE
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:SUE
Last Name:RITTER
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 1:3810 W GOLDEN KEYS WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226
Mailing Address - Country:US
Mailing Address - Phone:480-636-1801
Mailing Address - Fax:480-636-1801
Practice Address - Street 1:2600 E SOUTHERN AVE
Practice Address - Street 2:F1
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:480-785-2869
Practice Address - Fax:480-636-1801
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1567101YA0400X
AZ10861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical