Provider Demographics
NPI:1265632400
Name:LANKA, RENEE JULIETTE (MS, LMFT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:JULIETTE
Last Name:LANKA
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:JULIETTE
Other - Last Name:BRAGONIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 3RD ST. NW
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-5195
Mailing Address - Country:US
Mailing Address - Phone:597-332-6115
Mailing Address - Fax:507-332-6247
Practice Address - Street 1:320 3RD ST NW
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021-5195
Practice Address - Country:US
Practice Address - Phone:597-332-6115
Practice Address - Fax:507-332-6247
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1603106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist