Provider Demographics
NPI:1508040783
Name:LEGRO, RENEE ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ANN
Last Name:LEGRO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:ANN
Other - Last Name:SZCZESNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:299 GUNSTOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:GILFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03249-7563
Mailing Address - Country:US
Mailing Address - Phone:603-293-0673
Mailing Address - Fax:888-827-3012
Practice Address - Street 1:299 GUNSTOCK HILL RD
Practice Address - Street 2:
Practice Address - City:GILFORD
Practice Address - State:NH
Practice Address - Zip Code:03249-7563
Practice Address - Country:US
Practice Address - Phone:603-293-0673
Practice Address - Fax:888-827-3012
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12026273235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1696OtherSPEECH LANGUAGE LICENSE
12026273OtherASHA
NH3111369Medicaid