Provider Demographics
NPI:1164075016
Name:ROHAN, RENEE JACOBS (MED)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:JACOBS
Last Name:ROHAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:ALISON
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:8833 JAMAC LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3833
Mailing Address - Country:US
Mailing Address - Phone:334-652-4081
Mailing Address - Fax:
Practice Address - Street 1:1286 PERRY HILL ROAD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-3610
Practice Address - Country:US
Practice Address - Phone:334-328-6615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3655235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist