Provider Demographics
NPI:1841418878
Name:BUCKINGHAM, RENEE KAYDAN (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:KAYDAN
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 GREENWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317
Mailing Address - Country:US
Mailing Address - Phone:724-746-1927
Mailing Address - Fax:
Practice Address - Street 1:289 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301
Practice Address - Country:US
Practice Address - Phone:724-223-7803
Practice Address - Fax:724-223-7804
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL007118235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist