Provider Demographics
NPI:1881669547
Name:ST.CLAIR, RENAE LYNN (ATC)
Entity Type:Individual
Prefix:MS
First Name:RENAE
Middle Name:LYNN
Last Name:ST.CLAIR
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 862
Mailing Address - Street 2:742 KRESSWOOD DR.
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-9014
Mailing Address - Country:US
Mailing Address - Phone:815-403-6614
Mailing Address - Fax:
Practice Address - Street 1:8311 N ROUTE 31
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IL
Practice Address - Zip Code:60071
Practice Address - Country:US
Practice Address - Phone:815-678-7561
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist