Provider Demographics
NPI:1245377498
Name:TRACHTENBERG, RENEE (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:RENEE
Middle Name:
Last Name:TRACHTENBERG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 CRESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3118
Mailing Address - Country:US
Mailing Address - Phone:516-791-3210
Mailing Address - Fax:516-791-3211
Practice Address - Street 1:844 CRESTVIEW AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-3118
Practice Address - Country:US
Practice Address - Phone:516-791-3210
Practice Address - Fax:516-791-3211
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001550-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist