Provider Demographics
NPI:1306679188
Name:HUSCHLE-RENK, SYDNIE LYSETTE
Entity type:Individual
Prefix:
First Name:SYDNIE
Middle Name:LYSETTE
Last Name:HUSCHLE-RENK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SYDNIE
Other - Middle Name:LYSSETTE
Other - Last Name:RENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8392B SYCAMORE CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME AFB
Mailing Address - State:ID
Mailing Address - Zip Code:83648-1331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8392B SYCAMORE CT
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME AFB
Practice Address - State:ID
Practice Address - Zip Code:83648-1331
Practice Address - Country:US
Practice Address - Phone:720-289-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID9861263101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health