Provider Demographics
NPI:1881140085
Name:PERONA, RENEE NICHOLE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:NICHOLE
Last Name:PERONA
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 1:1350 GRAND SUMMIT DRIVE
Mailing Address - Street 2:APT 45
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523
Mailing Address - Country:US
Mailing Address - Phone:916-801-2880
Mailing Address - Fax:
Practice Address - Street 1:1350 GRAND SUMMIT DR
Practice Address - Street 2:APT 45
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2586
Practice Address - Country:US
Practice Address - Phone:916-801-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVSP-1998 PROVISIONAL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist