Provider Demographics
NPI:1578117412
Name:RENJE, RAVEN (LPC-IT)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:RENJE
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5947 7TH AVE APT 3N
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4175
Mailing Address - Country:US
Mailing Address - Phone:262-210-2777
Mailing Address - Fax:
Practice Address - Street 1:2901 35TH ST LOWR SUITEB
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-5117
Practice Address - Country:US
Practice Address - Phone:262-764-2459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8286-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor