Provider Demographics
NPI:1336798255
Name:ROSENBERG, RENEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:FRIEDLANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:C/O EAST PRAIRIE SCHOOL
Mailing Address - Street 2:7616 N. EAST PRAIRIE ROAD
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-673-1141
Mailing Address - Fax:847-673-1186
Practice Address - Street 1:C/O EAST PRAIRIE SCHOOL
Practice Address - Street 2:7616 N. EAST PRAIRIE ROAD
Practice Address - City:SKOKE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-673-1141
Practice Address - Fax:847-673-1186
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-001921235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist