Provider Demographics
NPI:1790301786
Name:DANBERRY, RENAE C (LADC)
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:C
Last Name:DANBERRY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:W175N11120 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-4799
Mailing Address - Country:US
Mailing Address - Phone:800-438-1772
Mailing Address - Fax:262-345-5562
Practice Address - Street 1:44 GOOD COUNSEL DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6599
Practice Address - Country:US
Practice Address - Phone:800-438-7728
Practice Address - Fax:262-345-5562
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)