Provider Demographics
NPI:1124800461
Name:STUMPE, RENAE DAWN
Entity type:Individual
Prefix:
First Name:RENAE
Middle Name:DAWN
Last Name:STUMPE
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 1:5982 AUDRAIN ROAD 427
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-5521
Mailing Address - Country:US
Mailing Address - Phone:573-473-6096
Mailing Address - Fax:
Practice Address - Street 1:2690 THUNDERBIRD DR
Practice Address - Street 2:
Practice Address - City:KINGDOM CITY
Practice Address - State:MO
Practice Address - Zip Code:65262-1816
Practice Address - Country:US
Practice Address - Phone:573-386-2214
Practice Address - Fax:573-386-2169
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200358112355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant