Provider Demographics
NPI:1164286928
Name:FENECH, ELENA RENEE (MT-BC)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:RENEE
Last Name:FENECH
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24360 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5459
Mailing Address - Country:US
Mailing Address - Phone:734-307-8724
Mailing Address - Fax:
Practice Address - Street 1:24360 WILSON DR
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48183-5459
Practice Address - Country:US
Practice Address - Phone:734-307-8724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI18593225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist