Provider Demographics
NPI:1962689141
Name:ROWE, RENEE A (LMSW, ACSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:A
Last Name:ROWE
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 TANVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371-4761
Mailing Address - Country:US
Mailing Address - Phone:248-628-5587
Mailing Address - Fax:248-693-9615
Practice Address - Street 1:45 N LAPEER ST
Practice Address - Street 2:
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48362-3159
Practice Address - Country:US
Practice Address - Phone:248-693-9614
Practice Address - Fax:248-693-9615
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010697541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical