Individual
RENEE ROARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
110 MORDINGTON AVE, CHARLES TOWN, WV 25414-1693
(304) 725-9741
Mailing address
155 HUTTONS VIREO DR, MARTINSBURG, WV 25405-3923
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6980
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810004949
—
WV
Enumeration date
04/25/2008
Last updated
04/25/2008
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