Provider Demographics
NPI:1285040121
Name:RESZEL, RENEE ANN (MS)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ANN
Last Name:RESZEL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 EMERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-1706
Mailing Address - Country:US
Mailing Address - Phone:414-507-6100
Mailing Address - Fax:
Practice Address - Street 1:6233 DURAND AVE
Practice Address - Street 2:SUITE 102-3
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4961
Practice Address - Country:US
Practice Address - Phone:262-456-2384
Practice Address - Fax:262-456-2387
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3996-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1144664293Medicaid