Provider Demographics
NPI:1124242557
Name:HESS, RENEE JAHN (MSCCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:JAHN
Last Name:HESS
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:922 SHERBOURNE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5212
Mailing Address - Country:US
Mailing Address - Phone:561-351-7867
Mailing Address - Fax:
Practice Address - Street 1:922 SHERBOURNE CIR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5212
Practice Address - Country:US
Practice Address - Phone:561-351-7867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7223235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888-801-900Medicaid