Provider Demographics
NPI:1457726457
Name:ACRE, MARENA (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MARENA
Middle Name:
Last Name:ACRE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:MARENA
Other - Middle Name:
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:640 COUNTY ROAD 552
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-7809
Mailing Address - Country:US
Mailing Address - Phone:573-429-1631
Mailing Address - Fax:
Practice Address - Street 1:640 COUNTY ROAD 552
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-7809
Practice Address - Country:US
Practice Address - Phone:573-429-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008021059235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist