Provider Demographics
NPI:1750779732
Name:RENNOLET, AMANDA JANE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:JANE
Last Name:RENNOLET
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12247 STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8147
Mailing Address - Country:US
Mailing Address - Phone:515-393-6702
Mailing Address - Fax:
Practice Address - Street 1:12247 STRATFORD DR
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8147
Practice Address - Country:US
Practice Address - Phone:515-393-6702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-29
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1214101YA0400X
NE10474101YM0800X
IA082255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)