Provider Demographics
NPI:1235357880
Name:REAGAN, WILLIAM GEORGE (MA, SLP,CCC)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GEORGE
Last Name:REAGAN
Suffix:
Gender:M
Credentials:MA, SLP,CCC
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:GEORGE
Other - Last Name:REAGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA SLP, CCC
Mailing Address - Street 1:788 LEMON GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-4837
Mailing Address - Country:US
Mailing Address - Phone:805-650-7818
Mailing Address - Fax:
Practice Address - Street 1:10730 HENDERSON RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1832
Practice Address - Country:US
Practice Address - Phone:805-647-1141
Practice Address - Fax:805-647-1148
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA#3064235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist