Provider Demographics
NPI:1235418211
Name:RENEW, DEENA MELANE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:MELANE
Last Name:RENEW
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-2940
Mailing Address - Country:US
Mailing Address - Phone:229-244-4545
Mailing Address - Fax:229-244-4244
Practice Address - Street 1:1701 N PATTERSON ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2940
Practice Address - Country:US
Practice Address - Phone:229-244-4545
Practice Address - Fax:229-244-4244
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005142235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist