Provider Demographics
NPI:1164679239
Name:ENWEFA, REGINA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:REGINA
Middle Name:L
Last Name:ENWEFA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 ONEAL LN # 156
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-3205
Mailing Address - Country:US
Mailing Address - Phone:601-918-1713
Mailing Address - Fax:
Practice Address - Street 1:2142 ONEAL LN # 156
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3205
Practice Address - Country:US
Practice Address - Phone:601-918-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5462235Z00000X
MSS2867235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist