Provider Demographics
NPI:1922745181
Name:RENNARD, BRIDGET ELISE (MHS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:ELISE
Last Name:RENNARD
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 CEDAR FIELD CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5727
Mailing Address - Country:US
Mailing Address - Phone:314-598-7915
Mailing Address - Fax:
Practice Address - Street 1:2 HARBOR BEND CT STE 102
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1480
Practice Address - Country:US
Practice Address - Phone:636-695-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000941235Z00000X
MO2022027499235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist