Provider Demographics
NPI:1598047391
Name:VANDERLAN, RENEE KATHRYN (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:KATHRYN
Last Name:VANDERLAN
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 1:6589 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-2210
Mailing Address - Country:US
Mailing Address - Phone:315-271-9126
Mailing Address - Fax:
Practice Address - Street 1:9508 ARTZ ROAD
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:NY
Practice Address - Zip Code:13305
Practice Address - Country:US
Practice Address - Phone:315-346-1211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021403235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist