Provider Demographics
NPI:1003321076
Name:REGNIER, COLLEEN ELIZABETH (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ELIZABETH
Last Name:REGNIER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:ELIZABETH
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:655 N 875TH RD
Mailing Address - Street 2:
Mailing Address - City:WENONA
Mailing Address - State:IL
Mailing Address - Zip Code:61377-9307
Mailing Address - Country:US
Mailing Address - Phone:217-714-4396
Mailing Address - Fax:
Practice Address - Street 1:117 W LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1821
Practice Address - Country:US
Practice Address - Phone:815-844-3023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.013384235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist