Provider Demographics
NPI:1639505183
Name:KORTE, RENAE JOAN
Entity Type:Individual
Prefix:
First Name:RENAE
Middle Name:JOAN
Last Name:KORTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LAURA LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-1048
Mailing Address - Country:US
Mailing Address - Phone:618-654-4714
Mailing Address - Fax:
Practice Address - Street 1:65 LAURA LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-1048
Practice Address - Country:US
Practice Address - Phone:618-654-4714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146004200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist