Provider Demographics
NPI:1225101645
Name:OUTLAW, RENEE C (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:C
Last Name:OUTLAW
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-4918
Mailing Address - Country:US
Mailing Address - Phone:360-696-6525
Mailing Address - Fax:702-737-8255
Practice Address - Street 1:611 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-4918
Practice Address - Country:US
Practice Address - Phone:360-696-6525
Practice Address - Fax:360-418-0418
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60099189235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508237Medicaid