Provider Demographics
NPI:1518133081
Name:RENO, AMY BETH (MS SLP CCC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:RENO
Suffix:
Gender:F
Credentials:MS SLP CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 ELM GROVE RD
Mailing Address - Street 2:SUITE 36
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2531
Mailing Address - Country:US
Mailing Address - Phone:414-303-5226
Mailing Address - Fax:
Practice Address - Street 1:910 ELM GROVE RD
Practice Address - Street 2:SUITE 36
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2531
Practice Address - Country:US
Practice Address - Phone:414-303-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1520-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist