Provider Demographics
NPI:1154377083
Name:WINFREY, REETA RENAE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:REETA
Middle Name:RENAE
Last Name:WINFREY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:RENAE
Other - Middle Name:R
Other - Last Name:WINFREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:2158 WILDERNESS TRL
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1266
Mailing Address - Country:US
Mailing Address - Phone:636-464-8411
Mailing Address - Fax:
Practice Address - Street 1:1 JEFFERSON BARRACKS DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4181
Practice Address - Country:US
Practice Address - Phone:314-894-6675
Practice Address - Fax:314-894-6615
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108890235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist