Provider Demographics
NPI:1518255603
Name:KINNARD, REGINA DARLENE (MED)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:DARLENE
Last Name:KINNARD
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 ALTON AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-2607
Mailing Address - Country:US
Mailing Address - Phone:248-818-6638
Mailing Address - Fax:
Practice Address - Street 1:594 ALTON AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2607
Practice Address - Country:US
Practice Address - Phone:248-818-6638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106899235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist