Provider Demographics
NPI:1134665706
Name:RENLEY, NATHAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:RENLEY
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:NATHAN
Other - Middle Name:COLLINS
Other - Last Name:BICKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 VIRGINIA DALE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-4034
Mailing Address - Country:US
Mailing Address - Phone:505-787-4864
Mailing Address - Fax:
Practice Address - Street 1:2925 VIRGINIA DALE DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-4034
Practice Address - Country:US
Practice Address - Phone:505-787-4864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP.0003257235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist