Renata Petrovna Chebotareva, M.S., CF-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

61098071 Issued in WA

Practice address

22443 SE 240TH St Ste B101
Maple Valley, WA 98038-5879

Phone

(425) 358-4885

Fax

(425) 358-7159

NPI assigned

Dec 21, 2020

Last updated

Dec 21, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rock Therapeutic Services LLC

  • Speech-Language Pathologist
  • Maple Valley, WA
  • NPI 1750667713
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1608508800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1659968923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22443 SE 240TH ST STE B101",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980385879",
            "telephone_number": "425-358-4885",
            "fax_number": "425-358-7159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22443 SE 240TH ST STE B101",
            "city": "MAPLE VALLEY",
            "state": "WA",
            "postal_code": "980385879",
            "telephone_number": "425-358-4885",
            "fax_number": "425-358-7159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEBOTAREVA",
        "first_name": "RENATA",
        "middle_name": "PETROVNA",
        "credential": "M.S., CF-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-21",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "61098071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Casper M.a., Bcba, Lba, M.A. BCBA, LBA
• Nicholas Castagna, OD
• Jennifer A Castelluccio, PAC
• Elizabeth Jane Castillon
• Michelle Chang
• Cheng Im Shao Chue Gomez PLLC (Sunrise Dental of Maple Valley)
• Alexandra Chevrier, LMFTA
• Heather Ching, OD
• Brandon Christensen, LICSW
• Ifeanyi Charles Chukwu, M.ED.

• Speech-Language Pathologist in Maple Valley, WA
• Providers in Maple Valley, WA by specialty
• Speech-Language Pathologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.