Provider Demographics
NPI:1740591759
Name:FLACKSBARTH, RENEE D (HIS)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:D
Last Name:FLACKSBARTH
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 COUNTY ROAD B W
Mailing Address - Street 2:204
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-5021
Mailing Address - Country:US
Mailing Address - Phone:651-631-9363
Mailing Address - Fax:651-639-0896
Practice Address - Street 1:1611 COUNTY RD. B W.
Practice Address - Street 2:204
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-5021
Practice Address - Country:US
Practice Address - Phone:651-631-9363
Practice Address - Fax:651-639-0896
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2686237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist