MEDICARE: RENEE FRANCES KIRBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7101003236	MI

General Provider Information

NPI Number	:	1376037085
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE FRANCES KIRBY

Provider Business Mailing Address
First Line	:	3010 SAINT JUDE DR
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-4356
Country	:	US
Telephone Number	:	248-917-2517
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 SAINT JUDE DR
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48329-4356
Country	:	US
Telephone Number	:	248-917-2517
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	06/15/2018

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Directions to “ RENEE FRANCES KIRBY ” Practice Location

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