Provider Demographics
NPI:1609344514
Name:RENICK, JENNIFER TERESEA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TERESEA
Last Name:RENICK
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 1:49110 DENTON RD APT 6
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-2178
Mailing Address - Country:US
Mailing Address - Phone:734-985-1422
Mailing Address - Fax:
Practice Address - Street 1:2750 CARPENTER RD STE 5
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1170
Practice Address - Country:US
Practice Address - Phone:517-230-5695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical