Provider Demographics
NPI:1518474709
Name:LA BELLA, RENEE (CLINSCID, CCC-SLP/L)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:LA BELLA
Suffix:
Gender:F
Credentials:CLINSCID, CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 LUNDVALL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3339
Mailing Address - Country:US
Mailing Address - Phone:815-218-7805
Mailing Address - Fax:
Practice Address - Street 1:501 7TH ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-1242
Practice Address - Country:US
Practice Address - Phone:815-967-8070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.004319235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNAMedicaid