Provider Demographics
NPI:1871262071
Name:RENHAM, SIERRA K
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:K
Last Name:RENHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:K
Other - Last Name:BONHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:3101 S FRONTAGE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-2545
Mailing Address - Country:US
Mailing Address - Phone:218-236-1494
Mailing Address - Fax:218-236-0836
Practice Address - Street 1:3101 S FRONTAGE RD STE 100
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2545
Practice Address - Country:US
Practice Address - Phone:218-236-1494
Practice Address - Fax:218-236-0836
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN272101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical