Provider Demographics
NPI:1699229880
Name:PONNIAH, RENUKA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:RENUKA
Middle Name:
Last Name:PONNIAH
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 1:4301 S PINE ST
Mailing Address - Street 2:STE 301
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7206
Mailing Address - Country:US
Mailing Address - Phone:253-476-6550
Mailing Address - Fax:253-476-6547
Practice Address - Street 1:1512 PIERCE AVE NE
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3374
Practice Address - Country:US
Practice Address - Phone:360-521-4209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist