=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972569788
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENA K GIRARD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2006
-----------------------------------------------------
Last Update Date | 07/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5005 CENTER ST STE H
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-472-6454
-----------------------------------------------------
Fax | 253-472-0699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5005 CENTER ST STE H
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-472-6454
-----------------------------------------------------
Fax | 253-472-0699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / THERAPIST
-----------------------------------------------------
Name | MS. RENA K GIRARD
-----------------------------------------------------
Credential | LICENSED SPEECH LANG
-----------------------------------------------------
Telephone | 253-472-6454
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | LL00001645
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------