Provider Demographics
NPI:1427293968
Name:RENNARD, DONNA ANN (LCPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:ANN
Last Name:RENNARD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4112
Mailing Address - Country:US
Mailing Address - Phone:708-769-1547
Mailing Address - Fax:630-790-1364
Practice Address - Street 1:215 W ELM ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-1862
Practice Address - Country:US
Practice Address - Phone:815-766-2740
Practice Address - Fax:630-790-1364
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006436101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)