Provider Demographics
NPI:1235203878
Name:REGAL, JEFFERY DAVID (AUD,CCC-A)
Entity Type:Individual
Prefix:DR
First Name:JEFFERY
Middle Name:DAVID
Last Name:REGAL
Suffix:
Gender:M
Credentials:AUD,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 JEFFREY LN
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-7706
Mailing Address - Country:US
Mailing Address - Phone:269-684-2324
Mailing Address - Fax:
Practice Address - Street 1:100 NAVARRE PLACE
Practice Address - Street 2:SUITE 4430
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1171
Practice Address - Country:US
Practice Address - Phone:574-246-1000
Practice Address - Fax:574-246-4000
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002023A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN233610CMedicare PIN