Provider Demographics
NPI:1689728727
Name:EICKMEIER, RENEE ANN (MA, CCC)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:ANN
Last Name:EICKMEIER
Suffix:
Gender:F
Credentials:MA, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 WILDBRIER DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2624
Mailing Address - Country:US
Mailing Address - Phone:636-227-9811
Mailing Address - Fax:
Practice Address - Street 1:15834 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011-2212
Practice Address - Country:US
Practice Address - Phone:636-227-2339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO105039235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist