MEDICARE: RENEW TELETHERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1043165400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENEW TELETHERAPY LLC

Provider Business Mailing Address
First Line	:	416 ARISTIDES WAY
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-2033
Country	:	US
Telephone Number	:	205-902-8268
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 ARISTIDES WAY
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30115-2033
Country	:	US
Telephone Number	:	205-902-8268
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MELISSA J DENNING
Credential	:	M.S. CCC-SLP
Telephone Number	:	205-902-8268

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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Directions to “RENEW TELETHERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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