Provider Demographics
NPI:1447229992
Name:REGAN, JENNIFER COGSWELL (ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COGSWELL
Last Name:REGAN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 TRAILSIDE LN
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-5016
Mailing Address - Country:US
Mailing Address - Phone:847-469-8525
Mailing Address - Fax:
Practice Address - Street 1:1285 N MCKINLEY RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1371
Practice Address - Country:US
Practice Address - Phone:847-582-7397
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer