Active NPI
Courtney Ruth Renner, LSW
- Social Worker
- Belleville, IL
National Provider Identifier
1730960089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 150.109779
- Practice address
- 12 N 64TH St
Belleville, IL 62223-3809 - Phone
- (618) 877-4420
- NPI assigned
- Oct 12, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 150.109779 | IL | Primary |
Addresses
Primary practice location
12 N 64TH St
Belleville, IL 62223-3809
Mailing address
448 Wylie Dr
Normal, IL 61761-5405
Phone (888) 924-3786
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 150.109779 | IL | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1697068800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697068800000",
"number": "1730960089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "448 WYLIE DR",
"city": "NORMAL",
"state": "IL",
"postal_code": "617615405",
"telephone_number": "888-924-3786"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 N 64TH ST",
"city": "BELLEVILLE",
"state": "IL",
"postal_code": "622233809",
"telephone_number": "618-877-4420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENNER",
"first_name": "COURTNEY",
"middle_name": "RUTH",
"credential": "LSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-10-12",
"last_updated": "2023-10-12",
"certification_date": "2023-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "IL",
"license": "150.109779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belleville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.