Provider Demographics
NPI:1972039287
Name:RENOUF, AMY M (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:RENOUF
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6196 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-9424
Mailing Address - Country:US
Mailing Address - Phone:231-624-2714
Mailing Address - Fax:
Practice Address - Street 1:1011 W MAPLE ST STE 300
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-5803
Practice Address - Country:US
Practice Address - Phone:269-343-7811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101002881235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist