Provider Demographics
NPI:1972569788
Name:RENA K GIRARD
Entity type:Organization
Organization Name:RENA K GIRARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:RENA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GIRARD
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED SPEECH LANG
Authorized Official - Phone:253-472-6454
Mailing Address - Street 1:5005 CENTER ST
Mailing Address - Street 2:STE H
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409
Mailing Address - Country:US
Mailing Address - Phone:253-472-6454
Mailing Address - Fax:253-472-0699
Practice Address - Street 1:5005 CENTER ST
Practice Address - Street 2:STE H
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409
Practice Address - Country:US
Practice Address - Phone:253-472-6454
Practice Address - Fax:253-472-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001645235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty