Provider Demographics
NPI:1326379348
Name:MATTSON, RENEE ANNE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ANNE
Last Name:MATTSON
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 1:1850 ASHLEY CROSSING LN
Mailing Address - Street 2:APT 23F
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5711
Mailing Address - Country:US
Mailing Address - Phone:315-525-9374
Mailing Address - Fax:
Practice Address - Street 1:1150 HUNGRYNECK BLVD
Practice Address - Street 2:SUITE C-364
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3484
Practice Address - Country:US
Practice Address - Phone:843-388-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-15
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4209235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist