Basic Information
| Provider Information | |||||||||
| NPI: | 1366561490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RENNICK | ||||||||
| FirstName: | SYDELLE | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 32706 VIA PALACIO | ||||||||
| Address2: | |||||||||
| City: | RANCHO PALOS VERDES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902755897 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103771924 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4655 RUFFNER ST STE 270 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921112276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007876787 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 6716 | CA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.