Provider Demographics
NPI:1306983465
Name:MILLWOOD, RENEE M (LCSW)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:M
Last Name:MILLWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13251
Mailing Address - Street 2:15655 COUNTY HWY B
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843
Mailing Address - Country:US
Mailing Address - Phone:715-634-0607
Mailing Address - Fax:715-634-0617
Practice Address - Street 1:15655 COUNTY HIGHWAY B
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843
Practice Address - Country:US
Practice Address - Phone:715-634-0607
Practice Address - Fax:715-634-0617
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2103-123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39686500Medicaid
WI2103-123OtherLICENSE NUMBER