Provider Demographics
NPI:1336256833
Name:LADWIG, RENEE JOANNE (CNS, LMFT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:JOANNE
Last Name:LADWIG
Suffix:
Gender:F
Credentials:CNS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N29W26690 PETERSON DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4469
Mailing Address - Country:US
Mailing Address - Phone:414-726-0024
Mailing Address - Fax:
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:JANE B. PETIT PAIN MANAGEMENT CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2775
Practice Address - Fax:414-266-1761
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI662-124106H00000X
WI77020-030163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health