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General NPI Number Information
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NPI Number | 1699229880
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Entity Type | Individual
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Provider Name | RENUKA PONNIAH M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/05/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 1512 PIERCE AVE NE
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City | RENTON
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State | WA
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Zip | 98056-3374
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Country | US
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Telephone | 360-521-4209
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Fax |
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Provider Business Mailing Address
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Address Line | 4301 S PINE ST STE 301
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City | TACOMA
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State | WA
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Zip | 98409-7206
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Country | US
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Telephone | 253-476-6550
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Fax | 253-476-6547
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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