Provider Demographics
NPI:1619208253
Name:SWANSON, RENAE D (PHD, LPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:RENAE
Middle Name:D
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PHD, LPC, NCC
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:D
Other - Last Name:RELJIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:404 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54901-4957
Mailing Address - Country:US
Mailing Address - Phone:920-385-6009
Mailing Address - Fax:
Practice Address - Street 1:404 N MAIN ST STE 612
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901
Practice Address - Country:US
Practice Address - Phone:920-385-6009
Practice Address - Fax:866-327-3295
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4226125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional