Provider Demographics
NPI:1114974177
Name:RENNE, DAVID A
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:RENNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 CHESHIRE PKWY N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55446-4103
Mailing Address - Country:US
Mailing Address - Phone:888-510-0766
Mailing Address - Fax:763-268-4430
Practice Address - Street 1:1038 116TH AVE NE
Practice Address - Street 2:STE 330
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4621
Practice Address - Country:US
Practice Address - Phone:425-455-5596
Practice Address - Fax:425-451-3248
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD00001946231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8443871Medicaid
WA8443871Medicaid