Healthcare Provider Details

I. General information

NPI: 1831330828
Provider Name (Legal Business Name): MRS. RENEE SUZANNE REYNOLDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2009
Last Update Date: 03/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 DIXIE DR
NEW LEBANON OH
45345-9746
US

IV. Provider business mailing address

1065 DIXIE DR
NEW LEBANON OH
45345-9746
US

V. Phone/Fax

Practice location:
  • Phone: 937-687-4287
  • Fax: 937-208-4515
Mailing address:
  • Phone: 937-687-4287
  • Fax: 937-208-4515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: