Provider Demographics
NPI:1659859189
Name:BEINE, BREANA RENEE
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:RENEE
Last Name:BEINE
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 1:421 PARK CHARLES BLVD S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3232
Mailing Address - Country:US
Mailing Address - Phone:636-734-5161
Mailing Address - Fax:
Practice Address - Street 1:300 KNAUST RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-1716
Practice Address - Country:US
Practice Address - Phone:636-281-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018025507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist