Provider Demographics
NPI:1225906852
Name:RENSHAW, LAURA
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:RENSHAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 COLLEGE VIEW DR APT 40
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-3768
Mailing Address - Country:US
Mailing Address - Phone:707-775-8422
Mailing Address - Fax:
Practice Address - Street 1:333 COLLEGE VIEW DR APT 40
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-3768
Practice Address - Country:US
Practice Address - Phone:707-775-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)