Provider Demographics
NPI:1356172985
Name:COLAW, REYENNE MCKINLEY (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:REYENNE
Middle Name:MCKINLEY
Last Name:COLAW
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 BLACK HAWK LN
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-5567
Mailing Address - Country:US
Mailing Address - Phone:304-668-9432
Mailing Address - Fax:
Practice Address - Street 1:1105 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7203
Practice Address - Country:US
Practice Address - Phone:301-739-5437
Practice Address - Fax:301-739-7453
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02979L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist