Provider Demographics
NPI:1083362701
Name:OKOGUN, REGINA EVIE (SLPA)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:EVIE
Last Name:OKOGUN
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 BRIGGS CHANEY RD
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1040
Mailing Address - Country:US
Mailing Address - Phone:301-802-6059
Mailing Address - Fax:
Practice Address - Street 1:10714 BALTIMORE AVENUE
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2112
Practice Address - Country:US
Practice Address - Phone:301-802-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00095L2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant