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General NPI Number Information
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NPI Number | 1972039287
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Entity Type | Individual
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Provider Name | AMY M RENOUF MA CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/05/2017
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Last Update Date | 05/05/2017
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Provider Practice Location Address
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Address Line | 1011 W MAPLE ST STE 300
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City | KALAMAZOO
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State | MI
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Zip | 49008-5803
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Country | US
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Telephone | 269-343-7811
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Fax |
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Provider Business Mailing Address
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Address Line | 6196 N 32ND ST
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City | RICHLAND
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State | MI
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Zip | 49083-9424
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Country | US
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Telephone | 231-624-2714
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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 | 7101002881
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License Number State | MI
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