Provider Demographics
NPI:1124321153
Name:RENESKI, SARAH LYNN (BA, BHRS)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:LYNN
Last Name:RENESKI
Suffix:
Gender:F
Credentials:BA, BHRS
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LYNN
Other - Last Name:SWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, BHRS
Mailing Address - Street 1:1383 LEHR ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-8535
Mailing Address - Country:US
Mailing Address - Phone:517-376-8340
Mailing Address - Fax:
Practice Address - Street 1:529 N GRAND ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3216
Practice Address - Country:US
Practice Address - Phone:580-234-8880
Practice Address - Fax:580-234-8891
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health