MEDICARE: RENEE LINDA GUSTIN M.S.,CCC-SLP

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	SA 14019	FL
2	235Z00000X	Speech-Language Pathologist	SP 12302	OH

General Provider Information

NPI Number	:	1720531478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE LINDA GUSTIN M.S.,CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 636256 CENTRAL CREDENTIALING
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-6256
Country	:	US
Telephone Number	:	513-585-5507
Fax Number	:	513-585-5511

Provider Business Practice Location Address
First Line	:	222 PIEDMONT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-0528
Country	:	US
Telephone Number	:	513-475-8400
Fax Number	:	513-475-8228

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

Provider Enumeration Date	:	07/29/2016
Last Update Date	:	12/11/2017

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Directions to “ RENEE LINDA GUSTIN M.S.,CCC-SLP” Practice Location

Language	Start Address	Practice Location

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