MEDICARE: RENEE WAHLENMAYER M.A., CCC-SLP

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	SL0008228	PA
2	235Z00000X	Speech-Language Pathologist	SP8424	OH

General Provider Information

NPI Number	:	1851727945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE WAHLENMAYER M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	2426 MAPLE AVE
Second Line	:
City	:	LAKE CITY
State	:	PA
Zip	:	16423-1339
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2426 MAPLE AVE
Second Line	:
City	:	LAKE CITY
State	:	PA
Zip	:	16423-1339
Country	:	US
Telephone Number	:	814-774-8009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	09/19/2013

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Directions to “ RENEE WAHLENMAYER M.A., CCC-SLP” Practice Location

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