Individual provider Active NPI

Renae Wood

  • Marriage & Family Therapist
  • Rockford, IL
National Provider Identifier
1710346689
Registry record updated Feb 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
166001046 Issued in IL
Practice address
6392 Linden Rd
Rockford, IL 61109-2816
Phone
(779) 368-0060
Fax
(779) 368-0579
NPI assigned
Feb 19, 2016
Last updated
Feb 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 19, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 166001046 IL Primary

Addresses

Primary practice location

6392 Linden Rd
Rockford, IL 61109-2816

Mailing address

6392 Linden Rd
Rockford, IL 61109-2816
Phone (779) 368-0060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240126003574 IL Practitioner - Marriage and Family Therapist 0648623561 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

6392 Linden Rd
Rockford, IL 61109-2816
Phone (779) 368-0060

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
166001046ILMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Behavioral Care Therapy Services of Illinois PC CurrentSince Mar 15, 2025 Accepting new patients
KP Counseling LTD CurrentSince Jan 1, 2024 Accepting new patients
Optum Behavioral Care Therapy Services of Illinois PC CurrentSince Mar 15, 2025 Accepting new patients

Locations

4753 N Broadway St
Ste 403
Chicago, IL 60640
Phone (773) 989-2780

12151 Regency Pkwy
Ste 12189
Huntley, IL 60142
Phone (779) 368-0660

1 Optum Cir
Eden Prairie, MN 55344
Phone (478) 234-8011

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455840000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1710346689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6392 LINDEN RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611092816",
            "telephone_number": "779-368-0060",
            "fax_number": "779-368-0579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6392 LINDEN RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611092816",
            "telephone_number": "779-368-0060",
            "fax_number": "779-368-0579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOD",
        "first_name": "RENAE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-19",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "IL",
            "license": "166001046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.