Provider Demographics
NPI:1376726588
Name:REYNA, ELAINE F (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:F
Last Name:REYNA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N ROBIN CT
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-3808
Mailing Address - Country:US
Mailing Address - Phone:219-201-1999
Mailing Address - Fax:
Practice Address - Street 1:440 EDMOND DR
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1523
Practice Address - Country:US
Practice Address - Phone:219-201-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009227235Z00000X
IN22005286A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist