Healthcare Provider Details

I. General information

NPI: 1609713924
Provider Name (Legal Business Name): AMY RENKEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 N CLARKSON ST STE 1
FREMONT NE
68025-7717
US

IV. Provider business mailing address

16425 OLIVE ST
OMAHA NE
68136-2083
US

V. Phone/Fax

Practice location:
  • Phone: 402-290-9908
  • Fax:
Mailing address:
  • Phone: 402-290-9908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AMY RENKEN
Title or Position: OWNER
Credential:
Phone: 402-290-9908