Provider Demographics
NPI:1730285198
Name:REPKA, RENEE JEAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:JEAN
Last Name:REPKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 PARK WEST BLVD
Mailing Address - Street 2:SUITE D1
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923
Mailing Address - Country:US
Mailing Address - Phone:865-691-2425
Mailing Address - Fax:865-531-8440
Practice Address - Street 1:9217 PARK WEST BLVD
Practice Address - Street 2:SUITE D1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923
Practice Address - Country:US
Practice Address - Phone:865-691-2425
Practice Address - Fax:865-531-8440
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1653103T00000X, 103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy