Provider Demographics
NPI:1922517507
Name:FEATHERSTONE, RENEE (HAD)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:FEATHERSTONE
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2814 PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-2561
Mailing Address - Country:US
Mailing Address - Phone:310-213-6668
Mailing Address - Fax:
Practice Address - Street 1:451 E AVENIDA DE LOS ARBOLES STE B
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7609
Practice Address - Country:US
Practice Address - Phone:805-494-4469
Practice Address - Fax:805-492-1386
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8251237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00000Medicaid