Provider Demographics
NPI:1396853917
Name:MCDONOUGH-PYLE, REGINA M (SPEECH PATHOLOGIST)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:M
Last Name:MCDONOUGH-PYLE
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2301 JACKSBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2959
Mailing Address - Country:US
Mailing Address - Phone:423-566-2250
Mailing Address - Fax:423-566-5896
Practice Address - Street 1:2301 JACKSBORO PIKE
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2959
Practice Address - Country:US
Practice Address - Phone:423-566-2250
Practice Address - Fax:423-566-5896
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP1650235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNSP1650OtherSPEECH LICENSE #