Provider Demographics
NPI:1720827421
Name:EIKEN, RENATA M (CCC-SLP)
Entity type:Individual
Prefix:
First Name:RENATA
Middle Name:M
Last Name:EIKEN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:RENATA
Other - Middle Name:
Other - Last Name:MUENKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CF-SLP
Mailing Address - Street 1:702 HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:TRIMBLE
Mailing Address - State:MO
Mailing Address - Zip Code:64492
Mailing Address - Country:US
Mailing Address - Phone:573-821-3371
Mailing Address - Fax:
Practice Address - Street 1:18069 HIGHWAY 169
Practice Address - Street 2:
Practice Address - City:COSBY
Practice Address - State:MO
Practice Address - Zip Code:64436-8115
Practice Address - Country:US
Practice Address - Phone:573-821-3371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020012947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist