Renee Marie Penticoff, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP 4060 Issued in MN

Practice address

1818 Wooddale Dr
Suite 204
Woodbury, MN 55125-2940

Phone

(651) 255-6678

Fax

(651) 501-6091

NPI assigned

Sep 13, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Penticoff Community Counseling, Inc.

  • Clinical Psychologist
  • Woodbury, MN
  • NPI 1588896310
  NPD (past) Authorized official

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962506493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25334",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551250334",
            "telephone_number": "651-255-6678",
            "fax_number": "651-501-6091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 WOODDALE DR",
            "address_2": "SUITE 204",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551252940",
            "telephone_number": "651-255-6678",
            "fax_number": "651-501-6091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENTICOFF",
        "first_name": "RENEE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP 4060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Orthotic and Prosthetic Services - Midwest, LLC
• Lori Peiffer, L.P.
• Ashley Lynn Peine, PA-C
• Jeffrey Craig Pellersels, DPM
• Penticoff Community Counseling, Inc.
• Peoplefirst Clinic PLLC
• Allison Peper
• Scott Randall Pepin, M.D.
• Percy Nelson Enterpries Inc
• Jayson Robert Pereira, M.D.

• Clinical Psychologist in Woodbury, MN
• Providers in Woodbury, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.