Provider Demographics
NPI:1942015342
Name:SPONEM, RENEE ANN (LMT)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ANN
Last Name:SPONEM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S10381 COUNTY ROAD C
Mailing Address - Street 2:
Mailing Address - City:SAUK CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53583-9636
Mailing Address - Country:US
Mailing Address - Phone:608-574-5125
Mailing Address - Fax:
Practice Address - Street 1:1206 N JOHNS ST
Practice Address - Street 2:
Practice Address - City:DODGEVILLE
Practice Address - State:WI
Practice Address - Zip Code:53533-1279
Practice Address - Country:US
Practice Address - Phone:608-574-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13030-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist