Provider Demographics
NPI:1972703718
Name:RIENECKE, RENEE DAWN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:DAWN
Last Name:RIENECKE
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 1:3941 N WASHTENAW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5997
Mailing Address - Country:US
Mailing Address - Phone:773-497-6838
Mailing Address - Fax:
Practice Address - Street 1:DENVER HEALTH AND HOSPITAL AUTHORITY
Practice Address - Street 2:777 BANNOCK ST.
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204
Practice Address - Country:US
Practice Address - Phone:866-824-4306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007132103TC0700X
COPSY.0006378103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical