Provider Demographics
NPI:1083959381
Name:HEDGES, RENEE (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:
Last Name:HEDGES
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SMITH DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3020
Mailing Address - Country:US
Mailing Address - Phone:314-420-4018
Mailing Address - Fax:
Practice Address - Street 1:122 SMITH DR
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-3020
Practice Address - Country:US
Practice Address - Phone:314-420-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist