Provider Demographics
NPI:1225021330
Name:STUEBER, RENAE SUZANNE (MS, CCC)
Entity Type:Individual
Prefix:MRS
First Name:RENAE
Middle Name:SUZANNE
Last Name:STUEBER
Suffix:
Gender:F
Credentials:MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8138 COUNTY ROAD 144
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-1380
Mailing Address - Country:US
Mailing Address - Phone:218-838-4271
Mailing Address - Fax:218-824-7030
Practice Address - Street 1:200 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-3268
Practice Address - Country:US
Practice Address - Phone:218-824-7030
Practice Address - Fax:218-824-7030
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN874S3ZIOtherBCBS OF MN