Provider Demographics
NPI:1528048741
Name:OURADNIK, RENEE MARY (LLP- LIMITED LICENSE)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MARY
Last Name:OURADNIK
Suffix:
Gender:F
Credentials:LLP- LIMITED LICENSE
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:MARY
Other - Last Name:LAPALM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TLLP AND/OR LLP
Mailing Address - Street 1:2920 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ESCANABA
Mailing Address - State:MI
Mailing Address - Zip Code:49829-9597
Mailing Address - Country:US
Mailing Address - Phone:906-786-4797
Mailing Address - Fax:906-786-6762
Practice Address - Street 1:2001 N LINCOLN RD RM CB230
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-2510
Practice Address - Country:US
Practice Address - Phone:906-786-4797
Practice Address - Fax:906-786-6762
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361005743103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6361005743OtherMICHIGAN BOARD OF PSYCHOLOGY
MI11255985OtherCAQH #