Provider Demographics
NPI:1326188418
Name:SCANNELL, REGINA MARIE (BS SLP)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:MARIE
Last Name:SCANNELL
Suffix:
Gender:F
Credentials:BS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 E BASELINE RD APT 213
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-9103
Mailing Address - Country:US
Mailing Address - Phone:360-303-7418
Mailing Address - Fax:
Practice Address - Street 1:4101 E BASELINE RD APT 213
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-9103
Practice Address - Country:US
Practice Address - Phone:360-303-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPL5054235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist