Provider Demographics
NPI:1851831341
Name:BREED, RENEE
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:BREED
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 1:1510 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-6318
Mailing Address - Country:US
Mailing Address - Phone:918-708-2119
Mailing Address - Fax:888-391-9543
Practice Address - Street 1:1510 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-6318
Practice Address - Country:US
Practice Address - Phone:918-708-2119
Practice Address - Fax:888-391-9543
Is Sole Proprietor?:No
Enumeration Date:2017-03-02
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist