Provider Demographics
NPI:1104411768
Name:SPERRY, RENE KATHLEEN (CP 60144992)
Entity type:Individual
Prefix:
First Name:RENE
Middle Name:KATHLEEN
Last Name:SPERRY
Suffix:
Gender:F
Credentials:CP 60144992
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19351 8TH AVE NE STE 141
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7087
Mailing Address - Country:US
Mailing Address - Phone:360-876-9430
Mailing Address - Fax:360-598-4114
Practice Address - Street 1:19351 8TH AVE NE STE 141
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7087
Practice Address - Country:US
Practice Address - Phone:360-876-9430
Practice Address - Fax:360-598-4114
Is Sole Proprietor?:No
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)