Provider Demographics
NPI:1043466105
Name:REGAN, JAMES M (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:REGAN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:414 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2208
Mailing Address - Country:US
Mailing Address - Phone:814-453-7967
Mailing Address - Fax:814-453-7967
Practice Address - Street 1:486 SOUTH MAIN STREET
Practice Address - Street 2:ANDOVER VILLAGE RETIREMENT CENTER
Practice Address - City:ANDOVER
Practice Address - State:OH
Practice Address - Zip Code:44003
Practice Address - Country:US
Practice Address - Phone:440-293-5416
Practice Address - Fax:440-293-6079
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-08
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 7879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist