Provider Demographics
NPI:1669031506
Name:RENTNER, CHRISTINA MARIE
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:RENTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 NEWBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-2738
Mailing Address - Country:US
Mailing Address - Phone:847-533-7203
Mailing Address - Fax:
Practice Address - Street 1:615 NEWBERRY DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-2738
Practice Address - Country:US
Practice Address - Phone:847-533-7203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.004919235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist