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General NPI Number Information
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NPI Number | 1841457686
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Entity Type | Individual
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Provider Name | RENEE LAVERNE BARNES-MALONE SPEECH THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 05/20/2008
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 100 N MAIN ST
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City | SUFFOLK
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State | VA
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Zip | 23434-4529
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Country | US
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Telephone | 757-925-6750
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Fax |
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Provider Business Mailing Address
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Address Line | 1407 LAFAYETTE BLVD
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City | NORFOLK
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State | VA
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Zip | 23509-1035
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Country | US
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Telephone | 757-621-1022
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Fax |
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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 | 2202001976
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License Number State | VA
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