Provider Demographics
NPI:1487803862
Name:RENKEN, AMY SUE (MS)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:SUE
Last Name:RENKEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16425 OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-2083
Mailing Address - Country:US
Mailing Address - Phone:402-895-4858
Mailing Address - Fax:
Practice Address - Street 1:4239 FARNAM ST
Practice Address - Street 2:SUITE 509
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2868
Practice Address - Country:US
Practice Address - Phone:402-551-7338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE711235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist