Provider Demographics
NPI:1134311103
Name:HOWARD, RENEE LOUISE (MA-CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:LOUISE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MA-CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 WHITE OAK LN
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-9663
Mailing Address - Country:US
Mailing Address - Phone:541-810-1805
Mailing Address - Fax:
Practice Address - Street 1:380 WHITE OAK LN
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-9663
Practice Address - Country:US
Practice Address - Phone:541-810-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR#32148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR27466Medicaid