Healthcare Provider Details

I. General information

NPI: 1659209534
Provider Name (Legal Business Name): SOPHIE RENNIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 MILITARY TPKE
PLATTSBURGH NY
12901-7457
US

IV. Provider business mailing address

200 HARKNESS RD
PERU NY
12972-3904
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-0100
  • Fax:
Mailing address:
  • Phone: 518-593-4924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: