Provider Demographics
NPI:1477216737
Name:STEVEN, RENE S (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:S
Last Name:STEVEN
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 1:4930 S DESOTO LN
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-7671
Mailing Address - Country:US
Mailing Address - Phone:414-331-7526
Mailing Address - Fax:
Practice Address - Street 1:8585 W FOREST HOME AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3467
Practice Address - Country:US
Practice Address - Phone:414-529-8500
Practice Address - Fax:414-529-8511
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI612-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist